Ueda Riyo, Shimizu-Motohashi Yuko, Sugai Kenji, Takeshita Eri, Ishiyama Akihiko, Saito Takashi, Komaki Hirofumi, Nakagawa Eiji, Sasaki Masayuki
Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan; Division of Frontier Medicine and Pharmacy, Graduate School of Medical and Pharmaceutical Science, Chiba University, Japan.
Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan.
Epilepsy Behav. 2018 Jul;84:122-126. doi: 10.1016/j.yebeh.2018.05.006. Epub 2018 May 20.
Diagnosis of seizure imitators in children is often challenging, and individuals with intellectual disability (ID) could be at additional risk of seizure imitator misdiagnosis. We aimed to elucidate distinct features of clinical semiology among children of different intellectual levels, which may help in distinguishing seizure imitators from epilepsy in such individuals. We retrospectively compared semiological features of seizure imitators in children with and without ID captured using video-electroencephalography (video-EEG). Seizure imitators were classified based on the definition of the International League Against Epilepsy (ILAE). A total of 67 individuals (mean age: 8.4 years, SD: 4.2 years) with seizure imitators documented using long-term video-EEG were identified, in which 27 patients had normal IQ/DQ, 20 had moderate ID, and 20 had severe ID. There was no statistically significant difference in the semiological features of seizure imitators between individuals with ID and those without ID; similarly, no difference was found between those with moderate ID and severe ID compared with individuals with normal IQ/DQ. Among all the patients, altered responsiveness mimicking cognitive or absence seizures was most frequently observed (36%), followed by jerks mimicking myoclonic seizures (22%). The most common seizure imitators among all the patients were unclassifiable nonepileptic seizures per the ILAE definition (28 cases, 42%), followed by day dreaming (24 cases, 36%) and physiological myoclonus (14 cases, 21%). In summary, the present study found no marked difference in semiological features of seizure imitators between patients with ID and those without ID regardless of ID severity, suggesting the necessity of early video-EEG for correct diagnosis.
儿童癫痫模仿者的诊断往往具有挑战性，而智力残疾（ID）个体可能面临癫痫模仿者误诊的额外风险。我们旨在阐明不同智力水平儿童临床症状学的独特特征，这可能有助于在此类个体中将癫痫模仿者与癫痫区分开来。我们回顾性比较了使用视频脑电图（video-EEG）记录的有和没有ID的儿童癫痫模仿者的症状学特征。癫痫模仿者根据国际抗癫痫联盟（ILAE）的定义进行分类。共识别出67名有长期视频脑电图记录的癫痫模仿者个体（平均年龄：8.4岁，标准差：4.2岁），其中27例患者智商/发育商（IQ/DQ）正常，20例有中度ID，20例有重度ID。有ID个体和无ID个体之间癫痫模仿者的症状学特征无统计学显著差异；同样，与IQ/DQ正常的个体相比，中度ID和重度ID个体之间也未发现差异。在所有患者中，最常观察到模仿认知或失神发作的反应性改变（36%），其次是模仿肌阵挛发作的抽搐（22%）。根据ILAE定义，所有患者中最常见的癫痫模仿者是无法分类的非癫痫性发作（28例，42%），其次是白日梦（24例，36%）和生理性肌阵挛（14例，21%）。总之，本研究发现无论ID严重程度如何，有ID患者和无ID患者之间癫痫模仿者的症状学特征均无明显差异，这表明早期视频脑电图对于正确诊断的必要性。
