Zhang Bo, Wang Jing, Wang Mengyang, Wang Xiongfei, Guan Yuguang, Liu Zhao, Zhang Yao, Liu Changqing, Zhao Meng, Xie Pandeng, Zhu Mingwang, Li Tianfu, Luan Guoming, Zhou Jian
Department of Neurosurgery, Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Epilepsy Research, Sanbo Brain Hospital, Capital Medical University, Beijing, China.
Department of Neurology, Center of Epilepsy, Beijing Institute for Brain Disorders, Sanbo Brain Hospital, Capital Medical University, Beijing, China.
Front Neurol. 2022 Jun 10;13:917079. doi: 10.3389/fneur.2022.917079. eCollection 2022.
Ictal semiology is a fundamental part of the presurgical evaluation of patients with temporal lobe epilepsy. We aimed to identify different anatomical and semiologic subgroups in temporal lobe seizures, and investigate the correlation between them.
We enrolled 93 patients for whom stereoelectroencephalography exploration indicated that the seizure-onset zone was within the temporal lobe. Ictal signs and concomitant stereoelectroencephalography changes were carefully reviewed and quantified, and then cluster analysis and the Kendall correlation test were used to associate ictal signs with the temporal structures of patients.
Clustering analysis identified two main groups of temporal structures. Group 1 consisted of the medial temporal lobe structures and the temporal pole, which were divided into two subgroups. Group 1A included the hippocampal head, hippocampal body, and amygdala, and this subgroup correlated significantly with oroalimentary automatisms, feeling of fear, and epigastric auras. Group 1B included the hippocampal tail, temporal pole, and parahippocampal gyrus, and this subgroup correlated significantly with manual and oroalimentary automatisms. Group 2 consisted of the cortical structures of the temporal lobe and was also divided into two subgroups. Group 2A included the superior and middle temporal gyrus, correlated significantly with bilateral rictus/facial contraction, generalized tonic-clonic seizure, and manual automatisms. Group 2B included Heschl's gyrus, the inferior temporal gyrus, and the fusiform gyrus, and this subgroup correlated significantly with auditory auras, focal hypokinetics, unilateral upper and lower limbs tonic posture/clonic signs, head/eye deviation, unilateral versive signs, and generalized tonic-clonic seizure.
The temporal structures can be categorized according to the level at which each structure participates in seizures, and different anatomical subgroups can be correlated with different ictal signs. Identifying specific semiologic features can help us localize the epileptogenic zone and thus develop stereoelectroencephalography electrode implantation and surgical resection protocols for patients with temporal lobe epilepsy.
发作期症状学是颞叶癫痫患者术前评估的重要组成部分。我们旨在识别颞叶癫痫发作中的不同解剖学和症状学亚组，并研究它们之间的相关性。
我们纳入了93例患者，其立体脑电图检查显示癫痫发作起始区位于颞叶内。仔细回顾并量化发作期症状及同步的立体脑电图变化，然后采用聚类分析和肯德尔相关性检验将发作期症状与患者的颞叶结构相关联。
聚类分析确定了两组主要的颞叶结构。第1组由颞叶内侧结构和颞极组成，该组又分为两个亚组。第1A组包括海马头部、海马体和杏仁核，该亚组与口消化道自动症、恐惧感觉和上腹部先兆显著相关。第1B组包括海马尾部、颞极和海马旁回，该亚组与手部和口消化道自动症显著相关。第2组由颞叶皮质结构组成，也分为两个亚组。第2A组包括颞上回和颞中回，与双侧咧嘴/面部收缩、全身强直阵挛发作和手部自动症显著相关。第2B组包括颞横回、颞下回和梭状回，该亚组与听觉先兆、局灶性运动减少、单侧上肢和下肢强直姿势/阵挛体征、头/眼偏斜、单侧旋转体征和全身强直阵挛发作显著相关。
颞叶结构可根据各结构参与癫痫发作的程度进行分类，不同的解剖学亚组可与不同的发作期症状相关联。识别特定的症状学特征有助于我们定位致痫区，从而为颞叶癫痫患者制定立体脑电图电极植入和手术切除方案。
