Shimogori Kei, Doden Tadashi, Oguchi Kazuhiro, Hashimoto Takao
Department of Neurology, Aizawa Hospital, Matsumoto, Japan.
Department of Radiology, Aizawa Hospital, Matsumoto, Japan.
BMJ Case Rep. 2017 Jul 28;2017:bcr-2017-220139. doi: 10.1136/bcr-2017-220139.
We report on a 17-year-old girl with absence status epilepticus who developed recurrent motionless confusional state and continuous generalised 3-4 Hz rhythmic delta waves on electroencephalogram (EEG). The patient had no history of absence, myoclonus or generalised convulsion. Her seizure was resistant to a combination of antiepileptic drugs including carbamazepine. Ictal positron emission tomography using [F]fluorodeoxyglucose ([F]FDG-PET) revealed hypermetabolism of the bilateral thalamus and cerebellum and hypometabolism of the frontal, parietal and posterior cingulate cortices. We diagnosed her seizure as absence status and obtained remission by changing medication. The findings of ictal metabolic alteration in previous studies and in our case confirm the pathogenic importance of the thalamus in absence status and that associated cortical deactivation and cerebellar activation may be related to the generation or maintenance of epileptic EEG discharges.
我们报告了一名17岁患失神性癫痫持续状态的女孩，她出现反复的静止性意识模糊状态，脑电图（EEG）显示持续的广泛性3-4Hz节律性δ波。该患者无失神、肌阵挛或全身性惊厥病史。她的癫痫发作对抗癫痫药物联合治疗（包括卡马西平）耐药。使用[F]氟脱氧葡萄糖（[F]FDG-PET）进行的发作期正电子发射断层扫描显示双侧丘脑和小脑代谢增高，额叶、顶叶和后扣带回皮质代谢减低。我们将她的癫痫发作诊断为失神性癫痫持续状态，并通过更换药物获得缓解。既往研究及我们病例中的发作期代谢改变结果证实了丘脑在失神性癫痫持续状态中的致病重要性，且相关的皮质失活和小脑激活可能与癫痫性EEG放电的产生或维持有关。
