National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka, Japan.
Epilepsia Open. 2023 Mar;8(1):173-182. doi: 10.1002/epi4.12690. Epub 2023 Jan 29.
Periictal water drinking (PIWD), which is a rare seizure-related autonomic behavior, has been reported in temporal lobe epilepsy (TLE) but only rarely in extra-TLE. Additionally, the lateralizing value of PIWD is controversial. We aimed to clarify the occurrence and lateralizing value of PIWD in patients with focal epilepsy.
This retrospective study included 240 focal epilepsy patients aged >10 years with a favorable postoperative seizure outcome (Engel class I). PIWD was defined as water drinking behavior during a seizure or within 2 min in the postictal phase. The occurrence of PIWD documented on video-electroencephalogram monitoring was assessed. The lateralizing value of PIWD was analyzed among patients whose language dominant hemisphere was identified.
Twenty-three (9.5%) patients exhibited PIWD. PIWD occurred more frequently in frontal lobe epilepsy (FLE; eight of 41 patients, 19.5%) than in TLE (15 of 188 patients, 8%). The occurrence of PIWD was significantly different between FLE and extra-FLE (P = 0.035), with a low positive predictive value (34.8%). In FLE with PIWD, all but one patient underwent resective surgery involving the medial frontal lobe. In 194 patients whose language dominant hemisphere was determined, the lateralizing value of PIWD in FLE and TLE showed no statistical significance (P = 0.69 and P = 0.27, respectively).
Periictal water drinking occurred more often in FLE than TLE. Thus, PIWD might not be a specific periictal symptom in TLE. There was no evidence for the lateralizing value of PIWD in FLE and TLE. These findings can provide useful clinical clues for preoperative evaluations to estimate the epileptogenic zone based on seizure semiology and allow for a better understanding of pathophysiological insights into PIWD.
围痫期饮水（PIWD）是一种罕见的与癫痫发作相关的自主行为，已在颞叶癫痫（TLE）中报道，但在非颞叶癫痫（Extra-TLE）中很少见。此外，PIWD 的定位价值存在争议。我们旨在阐明局灶性癫痫患者中 PIWD 的发生和定位价值。
本回顾性研究纳入了 240 例年龄>10 岁且术后癫痫发作结果良好（Engel Ⅰ级）的局灶性癫痫患者。PIWD 定义为癫痫发作期间或发作后 2 分钟内饮水行为。评估视频-脑电图监测记录的 PIWD 发生情况。分析语言优势半球确定的患者中 PIWD 的定位价值。
23 例（9.5%）患者出现 PIWD。PIWD 在额叶癫痫（FLE；41 例中的 8 例，19.5%）中比 TLE（188 例中的 15 例，8%）更常见。FLE 和非 FLE 之间 PIWD 的发生有显著差异（P=0.035），阳性预测值较低（34.8%）。在 FLE 伴有 PIWD 的患者中，除 1 例外，所有患者均接受了涉及内侧额叶的切除术。在确定语言优势半球的 194 例患者中，FLE 和 TLE 中 PIWD 的定位价值无统计学意义（P=0.69 和 P=0.27）。
FLE 中 PIWD 的发生率高于 TLE。因此，PIWD 可能不是 TLE 特有的围痫期症状。FLE 和 TLE 中 PIWD 无定位价值的证据。这些发现可为术前评估提供有用的临床线索，根据发作的半定性估计致痫区，并更好地了解 PIWD 的病理生理学见解。
