Department of Neurology, General Hospital Hietzing-Neurological Center Rosenhügel, Riedelgasse 5, 1130, Vienna, Austria.
Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive Neurology, Vienna, Austria.
Clin Auton Res. 2019 Apr;29(2):137-150. doi: 10.1007/s10286-019-00596-x. Epub 2019 Feb 25.
To review the epidemiology and pathophysiology of autonomic symptoms and signs during epileptic seizures.
We performed a systematic literature search on the following autonomic symptoms and signs during epileptic seizures: cardiovascular changes, respiratory manifestations, gastrointestinal symptoms, cutaneous manifestations, sexual and genital manifestations, and urinary symptoms.
Autonomic symptoms and signs can represent the predominant symptom at the onset of a focal seizure, which would then lead to the seizure being classified as a focal onset autonomic seizure. Conversely, clinically relevant autonomic symptoms and signs frequently accompany seizures of focal, generalized, and/or unknown onset, but the seizure is regardless classified according to other, more relevant features. Autonomic symptoms and signs do not represent mere reactions to motor activity or other behavioral seizure manifestations, but rather they are generated by epileptic discharges affecting the central autonomic network. We have reviewed the localizing and lateralizing information currently available on the seizure onset zone and on seizure propagation pathways as provided by systematic analysis of specific autonomic seizure symptoms and signs. We present data on how autonomic seizure symptoms and signs are useful for gaining a better understanding of the anatomical and functional organization of the central autonomic network. Finally, we discuss the differential diagnosis of focal autonomic seizures with autonomic symptoms and signs representing the sole seizure manifestation versus various non-epileptic conditions.
Autonomic seizure symptoms and signs are relevant in clinical epileptology and open a unique window on the functional organization and pathophysiology of the central autonomic network.
回顾癫痫发作时自主症状和体征的流行病学和病理生理学。
我们对癫痫发作时的以下自主症状和体征进行了系统的文献检索：心血管变化、呼吸表现、胃肠道症状、皮肤表现、性和生殖表现以及泌尿系统症状。
自主症状和体征可作为局灶性癫痫发作起始时的主要症状，从而导致癫痫被归类为局灶性自主发作。相反，临床上相关的自主症状和体征经常伴随着局灶性、全身性和/或未知起源的癫痫发作，但根据其他更相关的特征，癫痫发作仍然被分类。自主症状和体征不仅仅是对运动活动或其他行为性癫痫发作表现的反应，而是由影响中枢自主网络的癫痫放电引起的。我们回顾了目前关于发作起始区和发作传播途径的定位和侧化信息，这些信息是通过对特定自主癫痫发作症状和体征的系统分析提供的。我们提供了数据，说明自主癫痫发作症状和体征如何有助于更好地理解中枢自主网络的解剖和功能组织。最后，我们讨论了以自主症状和体征为唯一发作表现的局灶性自主癫痫发作与各种非癫痫性疾病的鉴别诊断。
自主癫痫发作症状和体征在临床癫痫学中具有重要意义，为中枢自主网络的功能组织和病理生理学开辟了一个独特的窗口。
