Kurşun Oğuzhan, Karataş Hülya, Dericioğlu Neşe, Saygi Serap
Clinic of Neurology, Numune Training and Research Hospital, Ankara, Turkey.
Institute of Neurological Sciences and Psychiatry, Hacettepe University, Ankara, Turkey.
Noro Psikiyatr Ars. 2016 Sep;53(3):213-221. doi: 10.5152/npa.2016.13790. Epub 2016 Mar 1.
Specialized centers, in the management and surgical treatment of medically refractory epilepsy, emphasize the importance of differentiating the varieties of localization related epilepsies. There has been considerable recent interest in temporal and frontal lobe epileptic syndromes and less attention has been paid to parietal and occipital lobe epilepsies.
Here we report the clinical, electroencephalographic and neuroimaging characteristics of 46 patients with medically refractory lesional parietal lobe epilepsy who have been followed up for 1-10 years.
In this study auras were reported in 78.3% of the patients and included sensory symptoms (72.2%), headache (36.1%), nausea and vomiting (36.1%), psychic symptoms (36.1%) and visual symptoms (16.6%). The most common ictal behavioral changes were paresthesia (69.6%) and focal clonic activity (39.1%). Tonic posture, various automatisms, head deviation, staring, sensation of pain and speech disturbances occurred to a lesser extent. Simple partial seizures were present in 69.6%. Complex partial seizures occurred in 43.5% and secondary generalized tonic clonic seizures were reported in 58.7% of the patients. Interictal routine EEG disclosed abnormal background activity in 1/3 of the patients. Nonlocalising epileptiform abnormalities were found in 34.8% of the patients. EEG findings were normal in 34.8% of the patients. The most common presumed etiologic factors were as follows: posttraumatic encephalomalacia, stroke, tumor, malformation of cortical development, atrophy, and arteriovenous malformation.
Clinical, electrophysiological and neuroimaging features of the lesional symptomatic partial epilepsy patients may help us to localize the seizure focus in some patients with cryptogenic partial epilepsy. So that, the timing decision of the parietal lobe sampling with more invasive techniques like intracranial electrodes prior to epilepsy surgery would be easier.
在药物难治性癫痫的管理和外科治疗方面，专业中心强调区分各种局灶性癫痫的重要性。近期，人们对颞叶和额叶癫痫综合征颇感兴趣，而对顶叶和枕叶癫痫的关注较少。
本文报告了46例药物难治性局灶性顶叶癫痫患者的临床、脑电图及神经影像学特征，这些患者的随访时间为1至10年。
在本研究中，78.3%的患者报告有先兆症状，包括感觉症状（72.2%）、头痛（36.1%）、恶心和呕吐（36.1%）、精神症状（36.1%）以及视觉症状（16.6%）。最常见的发作期行为改变是感觉异常（69.6%）和局灶性阵挛活动（39.1%）。强直性姿势、各种自动症、头部偏斜、凝视、疼痛感觉及言语障碍的发生率较低。69.6%的患者出现单纯部分性发作。43.5%的患者出现复杂部分性发作，58.7%的患者报告有继发性全面性强直阵挛发作。发作间期常规脑电图显示，三分之一的患者背景活动异常。34.8%的患者发现非定位性癫痫样异常。34.8%的患者脑电图结果正常。最常见的推测病因如下：创伤后脑软化、中风、肿瘤、皮质发育畸形、萎缩以及动静脉畸形。
局灶性症状性部分性癫痫患者的临床、电生理及神经影像学特征可能有助于我们在某些隐源性部分性癫痫患者中定位癫痫病灶。这样一来，在癫痫手术前使用颅内电极等更具侵入性的技术进行顶叶采样的时机决策将更加容易。
