Lu J Y, Xue J, Gong P, Yang H P, Yang Z X
Department of Pediatrics,Peking University First Hospital,Beijing 100034, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2019 Jun 18;51(3):422-429. doi: 10.19723/j.issn.1671-167X.2019.03.008.
To investigate whether the tonic-clonic seizure (TCS) induced by intermittent photic stimulation (IPS)was generalized tonic-clonic seizure (GTCS)or partial secondarily tonic-clonic seizure (PGTCS),and to analyze the relationship between them.
Video-electroencephalogram (VEEG)database of Peking University First Hospital from March 2010 to October 2018 were reviewed. Fifteen cases with idiopathic epilepsy who had TCS induced by IPS were included in this study, and their clinical and electroencephalogram (EEG)characteristics were retrospectively analyzed.
In this study, 4 of the 15 cases were boys and 11 were girls. The age of seizure onset ranged from 1 to 13 years. According to the medical records: 12 cases were considered as GTCS,while the remaining 3 cases were considered as PGTCS. The age at VEEG monitoring ranged from 2.5 to 16.0 years. All backgrounds of the VEEG were normal. Interictal discharges:generalized discharges in 11 cases, of which 4 cases coexisted with posterior discharges, 2 cases coexisted with Rolandic discharges, the other 5 cases merely had generalized discharges; merely focal discharges in two cases, one in the Rolandic area and the other in the posterior area; no interictal discharge in the remaining 2 cases. IPS induced photoparoxysmal response (PPR)results: 2 cases without PPR,the remaining 13 cases with PPR of generalized discharges, and 6 of the 13 cases coexisted with posterior discharges. IPS induced photoconvulsive response (PCR)results: GTCS in one case (contradictory to medical history),PGTCS in 11 cases (consistent with medical history),and GTCS and PGTCS hardly to distinguish in the remaining 3 cases. Of the three conditions above, there were generalized myoclonic seizures induced by IPS before TCS in 7 cases.
The medical history was unreliable in determining whether TCS was generalized or focal. Myoclonic seizures can coexist with PGTCS, and sometimes GTCS was indistinguishable from PGTCS, indicating that the dichotomy of seizure types need to be improved. Photosensitive TCS should be regarded as a continuum between focal and generalized seizures.
探讨间歇性光刺激（IPS）诱发的强直阵挛发作（TCS）是全面性强直阵挛发作（GTCS）还是部分性继发强直阵挛发作（PGTCS），并分析两者之间的关系。
回顾北京大学第一医院2010年3月至2018年10月的视频脑电图（VEEG）数据库。本研究纳入15例因IPS诱发TCS的特发性癫痫患者，对其临床和脑电图（EEG）特征进行回顾性分析。
本研究中，15例患者中4例为男性，11例为女性。癫痫发作起始年龄为1至13岁。根据病历记录：12例被认为是GTCS，其余3例被认为是PGTCS。VEEG监测时的年龄为2.5至16.0岁。所有VEEG背景均正常。发作间期放电：11例为广泛性放电，其中4例合并后部放电，2例合并中央颞区放电，另外5例仅有广泛性放电；2例仅有局灶性放电，1例位于中央颞区，另1例位于后部；其余2例无发作间期放电。IPS诱发光阵发性反应（PPR）结果：2例无PPR，其余13例有广泛性放电的PPR，其中13例中有6例合并后部放电。IPS诱发光惊厥反应（PCR）结果：1例为GTCS（与病历记录矛盾），11例为PGTCS（与病历记录一致），其余3例中GTCS和PGTCS难以区分。在上述三种情况中，7例在TCS前有IPS诱发的广泛性肌阵挛发作。
病史在判断TCS是全面性还是局灶性方面不可靠。肌阵挛发作可与PGTCS共存，有时GTCS与PGTCS难以区分，表明癫痫发作类型的二分法需要改进。光敏性TCS应被视为局灶性和全面性发作之间的连续体。
