National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorders, Urushiyama 886, Aoi-ku, Shizuoka, Japan; Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan, Thailand.
National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorders, Urushiyama 886, Aoi-ku, Shizuoka, Japan.
Epilepsy Res. 2021 Feb;170:106553. doi: 10.1016/j.eplepsyres.2021.106553. Epub 2021 Jan 7.
We investigated the semiology of focal onset bilateral motor (convulsive) seizure (FBMS) in patients with intractable focal epilepsy who underwent epilepsy surgery to understand its value in localizing the origin of the seizure.
The study included 20 patients who underwent resective surgery after intracranial video-EEG monitoring (iEEG) with a favorable seizure outcome (Engel class I), and had at least one FBMS during iEEG. The diagnosis was mesial temporal lobe epilepsy (MTLE) for 7 patients and neocortical epilepsy (NE) for 13 patients (lateral temporal lobe, 3; posterior cortex, 6; frontal lobe, 3; perirolandic, 1). Videotaped FBMSs were carefully analyzed.
A generalized tonic phase appeared in all 7 patients with MTLE, but was absent in 6 of the 13 patients with NE (P = .044). Tonic cry was more frequently observed in MTLE than in NE (P = .012). Facial tonicity preceding limb tonicity was more frequently seen in patients with MTLE (P = .001).
Notably, patients with MTLE and those with NE showed semiological differences during bilateralization. FBMS includes not only focal to bilateral tonic-clonic seizure but also focal to bilateral clonic seizure.
我们研究了接受癫痫手术的难治性局灶性癫痫患者局灶性双侧运动（惊厥性）发作（FBMS）的症状学，以了解其在定位发作起源中的价值。
本研究纳入了 20 例接受颅内视频脑电图监测（iEEG）后行切除术的患者，这些患者具有良好的癫痫发作结局（Engel 分级 I），并且在 iEEG 期间至少有一次 FBMS。7 例诊断为内侧颞叶癫痫（MTLE），13 例诊断为皮质癫痫（NE）（外侧颞叶 3 例，后皮质 6 例，额叶 3 例，旁中央回 1 例）。仔细分析录像 FBMS。
7 例 MTLE 患者均出现全身性强直期，但 13 例 NE 患者中 6 例无强直期（P =.044）。强直期哭声在 MTLE 中比在 NE 中更常见（P =.012）。面肌强直先于肢体强直在 MTLE 患者中更常见（P =.001）。
值得注意的是，MTLE 患者和 NE 患者在双侧化过程中表现出不同的症状。FBMS 不仅包括局灶性双侧强直-阵挛发作，还包括局灶性双侧阵挛发作。
