Ide M, Jimbo M, Yamamoto M, Tanaka N, Takeyama E, Kubo O
Department of Neurosurgery, Dai-ni Hospital, Tokyo Women's Medical College, Japan.
No Shinkei Geka. 1988 Apr;16(4):415-9.
A 15-year-old girl was admitted to our clinic on July 16, 1985 with the epilepsy which had been resistant to various anticonvulsant therapies. At the age of 10 years automatism seizure, characterized by purposeless movement of arms and head of which the patient was unaware, began to occur and became as frequent as two to three times each day. From the age of 13 years, there were also grand mal seizures several times a year in spite of medical treatment. She had normal delivery and no history of febrile convulsion. There was no family history of epilepsy or mental disease. When examined on admission, she had normal personality and intelligence. There was no neurological abnormality. She complained of sleepiness and hirsutiness. Fit of automatism occurred two to three times a day during admission, though the blood levels of anticonvulsant drugs such as phenobarbital, phenytoin and carbamazepine reached to therapeutic concentration. EEG examination including infratemporal lead recording showed right temporal spike focus. But all the neuroradiological studies such as skull X-rays, CT, cerebral angiography and magnetic resonance imaging failed to show abnormal finding. Right temporal lobectomy was carried out under general anesthesia on Aug 22, 1985, and anterior two-thirds of the middle and the inferior temporal gyri were resected deeply to anterior hippocampus. To the naked eye, no abnormal finding was noted during the operation. In the surgical specimen, macroscopically nothing abnormal was found. Microscopically, serial sections of the lobe revealed clusters of oligodendroglial cells in cortical to subcortical region of the medial basal part of the temporal lobe.(ABSTRACT TRUNCATED AT 250 WORDS)
1985年7月16日,一名15岁女孩因对各种抗惊厥疗法均有抵抗性的癫痫症入住我们的诊所。10岁时开始出现自动症发作,其特征为手臂和头部无目的运动,患者对此毫无察觉,且发作频率高达每天两到三次。从13岁起,尽管接受了治疗,但每年仍会出现几次大发作。她顺产,无高热惊厥史。无癫痫或精神疾病家族史。入院检查时,她性格和智力正常。无神经学异常。她主诉嗜睡和多毛。住院期间,自动症发作每天两到三次,尽管苯巴比妥、苯妥英和卡马西平等抗惊厥药物的血药浓度已达到治疗浓度。包括颞下导联记录在内的脑电图检查显示右颞叶有棘波灶。但所有神经放射学检查,如颅骨X线、CT、脑血管造影和磁共振成像均未发现异常。1985年8月22日在全身麻醉下进行了右颞叶切除术,切除了颞中回和颞下回前三分之二并深入到前海马体。手术中肉眼未发现异常。手术标本肉眼观察也未发现异常。显微镜下,该叶的连续切片显示颞叶内侧基底部分皮质至皮质下区域有少突胶质细胞簇。(摘要截取自250字)