Department of Neuroscience, St. Vincent's Hospital, University of Melbourne, Melbourne, Australia.
Department of Neuroscience, St. Vincent's Hospital, University of Melbourne, Melbourne, Australia.
Epilepsy Behav. 2021 Mar;116:107769. doi: 10.1016/j.yebeh.2021.107769. Epub 2021 Feb 5.
Bilateral tonic-clonic seizures are encountered in both focal and generalized epilepsies. We reviewed the literature regarding the presence of focal signs in generalized-onset tonic-clonic seizures (GOTCS) and the utility of semiology in differentiating those from focal to bilateral tonic-clonic seizures (FBTCS).
We conducted a comprehensive literature search using four electronic databases (Medline, Embase, Web of Science, and Psychinfo) and constructed a systematic review in keeping with the Preferred Items for Systematic Reviews and Meta-analyses guidelines.
We included 13 studies on focal semiological features of GOTCS. These studies included a total of 952 participants. The key focal signs described in GOTCS included: early head version, figure of four sign, asymmetric seizure termination, and a multitude of auras as well as automatisms. Additionally, we reviewed five studies that investigated the use of semiology to differentiate GOTCS from FBTCS; these studies had a total of 289 participants. Asymmetry in clonic phase, side-to-side axial movements, asymmetrical seizure termination, figure of four sign, index finger pointing, and fanning posture of the hand were found to be significantly more frequent in FBTCS compared with GOTCS. Furthermore, combinations of focal semiological features occurring in a single seizure were found to be suggestive of FBTCS rather than GOTCS.
Focal signs are often evident in GOTCS. Though the observation of multiple focal signs within a given seizure may be in favor of an FBTCS, our findings caution against differentiating between the two seizure types based on semiology alone due to considerable overlap in focal features.
局灶性和全面性癫痫均可出现双侧强直-阵挛发作。我们复习了关于全面性发作强直-阵挛发作（GOTCS）中存在局灶性体征的文献，并研究了症状学在鉴别这些发作是源自全面性还是双侧起源的局灶性强直-阵挛发作（FBTCS）中的作用。
我们使用四个电子数据库（Medline、Embase、Web of Science 和 Psychinfo）进行了全面的文献检索，并根据系统评价和荟萃分析的首选项目指南构建了系统综述。
我们纳入了 13 项关于 GOTCS 的局灶性症状学特征的研究。这些研究共纳入了 952 名参与者。在 GOTCS 中描述的主要局灶性体征包括：早期头部转动、“四字形”征、不对称性发作终止以及多种先兆和自动症。此外，我们还复习了五项研究，这些研究调查了使用症状学来区分 GOTCS 和 FBTCS；这些研究共有 289 名参与者。在 FBTCS 中，强直相的不对称性、头和身体的侧向运动、不对称性发作终止、“四字形”征、食指指向和手的扇形姿势比 GOTCS 更为常见。此外，单次发作中出现的局灶性症状学特征组合提示更可能是 FBTCS，而非 GOTCS。
局灶性体征在 GOTCS 中通常明显。虽然在单次发作中观察到多个局灶性体征可能有利于 FBTCS，但我们的研究结果表明，由于局灶性特征有相当大的重叠，不能仅凭症状学来区分这两种发作类型。
