Department of Neurology, Kenézy Gyula Campus, Faculty of Medicine, University of Debrecen, Hungary.
Division of Nuclear Medicine and Translational Imaging, Department of Medical Imaging, Faculty of Medicine, University of Debrecen, Hungary.
Epilepsy Behav. 2024 Oct;159:110006. doi: 10.1016/j.yebeh.2024.110006. Epub 2024 Aug 23.
Few studies demonstrated that focal epilepsy (FE) with left hemispheric (LH) seizure onset is more frequent than with right hemispheric (RH) seizure onset. In addition, patients with LH seizure onset show worse clinical course compared to those with RH seizure onset. The aim of our study was to investigate both issues in a great cohort of FE patients.
In the retrospective study, we reviewed the clinical and paraclinical data of 682 patients with exclusively LH or RH seizure onset. We ascertained the laterality of seizure onset mainly by ictal and postictal semiology and ictal EEG findings. In the absence of ictal data, the basis of lateralization was the evidence of unilateral structural brain abnormality together with a corresponding interictal EEG finding. The endpoint of analysis of the clinical course was the presence/absence of five-year remission on drug treatment in the first ten years of treatment.
Out of the 682 patients, 378 (55.4 per cent) had LH and 304 (44.6 per cent) had RH seizure onset. The difference was statistically significant (p = 0.04). Out of them, 213 LH and 156 RH patients were eligible to evaluate prognosis. Five-years-remission was attained by 71 patients (33.3 per cent) in the LH, and 65 (41.7 per cent) in the RH group. The difference was statistically significant (p = 0.05).
We demonstrated the LH dominance of seizure onset and the worse clinical course of the patients with LH seizure onset. The findings are manifestations of the lateralized epileptic propensity of the brain. The dissimilar clinical course of the patient with LH and RH seizure onset may shape the general prognostic scheme in FE patients.
少数研究表明，左半球（LH）起始的局灶性癫痫（FE）比右半球（RH）起始的更常见。此外，LH 起始发作的患者临床病程比 RH 起始发作的患者更差。我们的研究目的是在一个庞大的 FE 患者队列中研究这两个问题。
在回顾性研究中，我们回顾了 682 例仅 LH 或 RH 起始发作的患者的临床和辅助检查数据。我们主要通过发作期和发作后症状学以及发作期脑电图发现来确定起始侧别。在没有发作期数据的情况下，侧别的依据是单侧结构性脑异常的证据，以及相应的发作间期脑电图发现。分析临床病程的终点是在治疗的前十年药物治疗是否达到五年缓解。
682 例患者中，378 例（55.4%）LH 起始发作，304 例（44.6%）RH 起始发作。差异有统计学意义（p=0.04）。其中，213 例 LH 和 156 例 RH 患者有资格评估预后。LH 组有 71 例（33.3%）患者达到五年缓解，RH 组有 65 例（41.7%）患者达到五年缓解。差异有统计学意义（p=0.05）。
我们证明了发作起始的 LH 优势和 LH 起始发作患者的临床病程较差。这些发现是大脑偏侧性癫痫倾向的表现。LH 和 RH 起始发作患者的不同临床病程可能会影响 FE 患者的一般预后方案。
