Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA.
Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA.
Epileptic Disord. 2023 Feb;25(1):1-17. doi: 10.1002/epd2.20045. Epub 2023 Apr 17.
Correctly diagnosing and classifying seizures and epilepsies is paramount to ensure the delivery of optimal care to patients with epilepsy. Focal seizures, defined as those that originate within networks limited to one hemisphere, are primarily subdivided into focal aware, focal impaired awareness, and focal to bilateral tonic-clonic seizures. Focal epilepsies account for most epilepsy cases both in children and adults. In children, focal epilepsies are typically subdivided in three groups: self-limited focal epilepsy syndromes (e.g., self-limited epilepsy with centrotemporal spikes), focal epilepsy of unknown cause but which do not meet criteria for a self-limited focal epilepsy syndrome, and focal epilepsy of known cause (e.g., structural lesions-developmental or acquired). In adults, focal epilepsies are often acquired and may be caused by a structural lesion such as stroke, infection and traumatic brain injury, or brain tumors, vascular malformations, metabolic disorders, autoimmune, and/or genetic causes. In addition to seizure semiology, neuroimaging, neurophysiology, and neuropathology constitute the cornerstones of a diagnostic evaluation. Patients with focal epilepsy who become drug-resistant should promptly undergo assessment in an epilepsy center. After excluding pseudo-resistance, these patients should be considered for presurgical evaluation as a means to identify the location and extent of the epileptogenic zone and assess their candidacy for a surgical procedure. The goal of this seminar in epileptology is to summarize clinically relevant information concerning focal epilepsies. This contributes to the ILAE's mission to ensure that worldwide healthcare professionals, patients, and caregivers continue to have access to high-quality educational resources concerning epilepsy.
正确诊断和分类癫痫发作和癫痫对于确保为癫痫患者提供最佳护理至关重要。局灶性发作是指起源于局限于一侧半球网络内的发作，主要分为局灶性意识清醒、局灶性意识障碍和局灶性双侧强直阵挛发作。局灶性癫痫在儿童和成人中占大多数癫痫病例。在儿童中，局灶性癫痫通常分为三组：自限性局灶性癫痫综合征（如自限性伴中央颞区棘波的癫痫）、原因不明但不符合自限性局灶性癫痫综合征标准的局灶性癫痫和已知病因的局灶性癫痫（如结构性病变-发育或获得性）。在成人中，局灶性癫痫通常是获得性的，可能由结构性病变引起，如中风、感染和创伤性脑损伤，或脑肿瘤、血管畸形、代谢紊乱、自身免疫和/或遗传原因。除了发作的症状学外，神经影像学、神经生理学和神经病理学是诊断评估的基石。对于成为药物难治性的局灶性癫痫患者，应迅速在癫痫中心进行评估。在排除假性耐药后，这些患者应考虑进行术前评估，以确定致痫区的位置和范围，并评估他们是否适合手术。本次癫痫学研讨会的目的是总结与局灶性癫痫相关的临床相关信息。这有助于 ILAE 的使命，即确保全球医疗保健专业人员、患者和护理人员继续获得有关癫痫的高质量教育资源。
