Department of Neurology, Bursa Uludağ University Medicine Faculty, Bursa, Türkiye.
Sci Rep. 2024 May 21;14(1):11578. doi: 10.1038/s41598-024-61401-y.
Seizure semiology and electroencephalograph (EEG) are very important for determining seizure type, hemisphere lateralization, or localization. Clinical symptoms of focal seizures, as well as findings at the onset or end of a focal to bilateral tonic-clonic seizure (FBTCS), are highly informative for lateralization. This study aimed to investigate the relationship of asymmetric last clonic jerk in patients with temporal or extratemporal lobe epilepsy with pathologies, localization, lateralization, or other semiological findings detected in neuroimaging or neuro psychometric tests and its positive predictive value for the detection of hemisphere lateralization based on seizure onset ictal EEG activation. 44 patients with asymmetric last clonic jerks (aLCJ) who were followed up in our VEM unit were randomized 1:1 with epilepsy patients without. In patients with ipsilateral automatism and contralateral posture or gustatory and olfactory hallucinations aLCJ was less or absent. In patients with unilateral tonic activity, aLCJ was more common. The positive predictive value of aLCJ for ictal EEG activation lateralization was 86.36%. In conclusion, asymmetric last clonic beat is valuable for lateralization of FBTCS and should be considered. Its presence strongly and reliably lateralizes to the side of seizure onset.
癫痫发作的症状学和脑电图（EEG）对于确定癫痫发作类型、半球侧化或定位非常重要。局灶性癫痫发作的临床症状，以及局灶性到双侧强直-阵挛发作（FBTCS）起始或结束时的发现，对于侧化具有高度信息性。本研究旨在探讨伴有颞叶或颞叶外病变的癫痫患者不对称最后阵挛性抽搐与神经影像学或神经心理测试中检测到的定位、侧化或其他症状学发现之间的关系，以及其对基于发作起始期 EEG 激活检测半球侧化的阳性预测值。在我们的 VEM 病房中，44 名出现不对称最后阵挛性抽搐（aLCJ）的患者与无癫痫患者以 1:1 的比例随机分组。在同侧自动症和对侧姿势或味觉和嗅觉幻觉的患者中，aLCJ 较少或不存在。在单侧强直活动的患者中，aLCJ 更为常见。aLCJ 对发作期 EEG 激活侧化的阳性预测值为 86.36%。总之，不对称最后阵挛性抽搐对于 FBTCS 的侧化具有重要价值，应予以考虑。其存在强烈且可靠地偏向于发作起始侧。
