National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorders, Urushiyama, Aoi-ku, Shizuoka, Department of Neurosurgery, Shiga University of Medical Science, Seta-Tsukinowa-Cho, Otsu, Shiga Japan.
National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorders, Urushiyama, Aoi-ku, Shizuoka.
Epileptic Disord. 2019 Apr 1;21(2):154-165. doi: 10.1684/epd.2019.1047.
Hyperkinetic seizures are usually associated with frontal lobe epilepsy. However, some patients have hyperkinetic seizures of temporal lobe origin. The semiological differences in hyperkinetic seizures between frontal and temporal lobe epilepsy have not been well studied. Here, we retrospectively assessed ictal semiology in order to distinguish between hyperkinetic seizures of frontal lobe origin and those of temporal lobe origin. We retrospectively reviewed data on patients who had undergone surgery for hyperkinetic seizures of temporal or frontal lobe origin and achieved favourable seizure outcomes (Engel Class I) with a minimum postoperative follow-up of 24 months. We reviewed seizure histories, imaging reports, video-EEG monitoring data, operative records, and pathological findings. We analysed and compared the hyperkinetic semiology of video-recorded seizures of temporal lobe origin and those of frontal lobe origin. Forty hyperkinetic seizures in eight patients (seven adult patients and one 12-year-old patient) with temporal lobe epilepsy and 45 hyperkinetic seizures in nine patients (eight adult patients and one 16-year-old patient) with frontal lobe epilepsy were analysed. Emotional facial expressions (such as fear, laughing, or anger), bilateral forceful elbow flexion, bilateral forceful grasping, facial flushing, and bilateral facial contraction were observed significantly more frequently in seizures of frontal lobe origin. Oroalimentary automatisms, seizures during wakefulness, salivation, and bilateral drop of the corners of the mouth were observed significantly more frequently in seizures of temporal lobe origin. Observation of a number of signs during hyperkinetic manifestations may help to predict whether a seizure originates from the frontal lobe or the temporal lobe.
发作性运动障碍通常与额叶癫痫相关。然而，一些患者的发作性运动障碍起源于颞叶。额叶癫痫和颞叶癫痫之间的发作性运动障碍的症状学差异尚未得到很好的研究。在此，我们回顾性评估了发作性运动障碍的症状学，以区分起源于额叶和颞叶的发作性运动障碍。我们回顾性分析了因颞叶或额叶起源的发作性运动障碍而接受手术且术后至少 24 个月随访达到良好癫痫结局（Engel 分级 I 级）的患者的资料。我们回顾了癫痫发作史、影像学报告、视频-脑电图监测数据、手术记录和病理发现。我们分析和比较了颞叶起源的发作性运动障碍和额叶起源的发作性运动障碍的运动症状。分析了 8 例颞叶癫痫患者（7 例成年患者和 1 例 12 岁患者）的 40 次发作性运动障碍和 9 例额叶癫痫患者（8 例成年患者和 1 例 16 岁患者）的 45 次发作性运动障碍。在额叶起源的发作性运动障碍中，更常观察到情绪性面部表情（如恐惧、大笑或愤怒）、双侧肘部强力弯曲、双侧强力握持、面部潮红和双侧面部收缩。在颞叶起源的发作性运动障碍中，更常观察到口面部自动症、觉醒期发作、流涎和双侧口角下垂。观察发作性运动障碍时的一些特征性表现可能有助于预测癫痫发作是否起源于额叶或颞叶。
