National Institute of Health and Medical Research, Institute of Systems Neuroscience, Aix Marseille University, Marseille, France.
Epileptology Department, Timone Hospital, Public Assistance Hospitals of Marseille, Marseille, France.
Epilepsia. 2020 May;61(5):1019-1026. doi: 10.1111/epi.16510. Epub 2020 May 7.
Hyperkinetic epileptic seizures (HKS) are difficult to characterize and localize according to semiologic features. We propose a multicriteria scale to help visual analysis and report results of cerebral localization.
We assessed seizures from 37 patients with HKS, explored with stereoelectroencephalography during presurgical evaluation. We used a multicriteria scale (hyperkinetic seizure scale [HSS]) with 10 semiologic features, scored independently by two neurologists. The item scores were used to group seizures using the k-means method. Semiologic features were correlated with the seizure onset zone (SOZ) localization (temporal, prefrontal dorsolateral, prefrontal ventromesial, parietal, insular).
Fifty-five seizures were analyzed, and each item of the HSS was compared between the two examiners with good interrater agreement (85.3%). Dystonia, integrated behavior, and bilateral or unilateral hyperkinetic movements were statistically significant according to localization. Three clusters were identified according to the HSS and correlated with different patterns of anatomic localization of SOZ. Cluster 1 was characterized clinically by asymmetric hyperkinetic movements associated with marked dystonia and vocalization. It mainly included parietal seizures. Cluster 2 was characterized by bilateral and symmetrical stereotyped hyperkinetic movements without dystonia. It represented half of temporal seizures and one-third of prefrontal seizures (dorsolateral). Cluster 3 was characterized by seizures with strong emotionality and vocalization with bilateral and symmetrical hyperkinetic movements and integrated behavior. It involved half of temporal seizures and a majority of prefrontal (ventromesial) seizures.
We propose a first attempt to quantify clinical patterns of HKS. The HSS may help to predict SOZ localization according to three main groups of hyperkinetic seizures.
根据半侧特征，难以对多动性癫痫发作（HKS）进行特征描述和定位。我们提出了一个多标准量表，以帮助视觉分析并报告大脑定位的结果。
我们评估了 37 例 HKS 患者的癫痫发作，这些患者在术前评估期间接受了立体脑电图检查。我们使用了一个包含 10 个半侧特征的多标准量表（多动性癫痫发作量表[HSS]），由两位神经科医生独立评分。使用 K-均值方法根据项目评分对发作进行分组。将半侧特征与发作起始区（SOZ）定位（颞叶、前额背外侧、前额腹内侧、顶叶、岛叶）相关联。
分析了 55 次发作，HSS 的每个项目在两位检查者之间的比较具有良好的组内一致性（85.3%）。根据定位，肌张力障碍、综合行为和双侧或单侧多动性运动具有统计学意义。根据 HSS 确定了三个聚类，与 SOZ 解剖定位的不同模式相关。聚类 1 在临床上表现为不对称的多动性运动，伴有明显的肌张力障碍和发声，主要包括顶叶发作。聚类 2 的特点是双侧和对称的刻板多动性运动，无肌张力障碍，代表了一半的颞叶发作和三分之一的前额叶（背外侧）发作。聚类 3 的特点是发作时伴有强烈的情感和发声，双侧和对称的多动性运动和综合行为，涉及一半的颞叶发作和大多数前额叶（腹内侧）发作。
我们首次尝试量化 HKS 的临床模式。HSS 可以帮助根据三组主要的多动性癫痫发作来预测 SOZ 定位。
