Clemens Béla, Dömötör Johanna
Debreceni Egyetem, Klinikai Központ, Neurológiai Klinika, Kenézy Gyula Campus.
Ideggyogy Sz. 2024 Sep 30;77(9-10):329-338. doi: 10.18071/isz.77.0329.
Combined epilepsy (with generalized and focal seizures) is a recently accepted and yet underreported epilepsy type. We intended to review the literature of combined epilepsy and to report the individual findings of the 31 combined epilepsy patients in our database. Thereafter, we investigated the characteristics of the patients at the group level.
The individual findings of the 31 patients were tabulated. We characterized the group with special reference to epidemiology, timing and the sequence of generalized and focal seizures, family history of seizures and severity of the electro-clinical phenotype. The variables were compared to those of the generalized epilepsy and the focal epilepsy groups of our database. We carried out statistical analyses by the two-sided Fishers's exact test and the Kruskal-Wallis and post-hoc Dunn tests.
The prevalence of combined epilepsy was 1.56% within the total sample of the classifiable epilepsy patients. Females were affected more often than males (67.7% and 32.3%, respectively). Statistically significant associations emerged firstly between the "short interval" subgroup (where the generalized and focal seizures occurred with short time difference) and the lack of other cerebral abnormality, and secondly between the "long interval" subgroup (where 4 to 37 years elapsed between the occurrence of the two seizure types) and the presence of other brain abnormality (p = 0.02). The proportion of patients with positive family history of seizures was greater in the combined epilepsy- than in the generalized epilepsy group (p = 0.03) and the focal epilepsy group (p < 0.0001) of the database. The electro-clinical phenotype of the absence seizures showed more atypical findings (indicating poor prognosis) in combined epilepsy than in the generalized absence epilepsy patients of the database (p < 0,0001). Despite dissimilar patient selection and study design, our main findings were in accord with those of prior studies. The dissection of the combined epilepsy group into the "long interval" and "short interval" subgroups was a novel approach that highlighted the dissimilar pathogenetic and clinical correlates of each.
The case reports might facilitate the spread of information about combined epilepsy in the medical community. Analyses of the patients at the group level resulted in clinically useful pieces of evidence.
合并性癫痫（兼具全身性发作和局灶性发作）是一种最近才被认可但报道较少的癫痫类型。我们旨在回顾合并性癫痫的相关文献，并报告我们数据库中31例合并性癫痫患者的个体研究结果。之后，我们在群体层面研究了这些患者的特征。
将31例患者的个体研究结果制成表格。我们特别从流行病学、全身性发作和局灶性发作的时间及发作顺序、癫痫家族史以及电临床表型的严重程度等方面对该群体进行了特征描述。将这些变量与我们数据库中全身性癫痫组和局灶性癫痫组的变量进行比较。我们采用双侧Fisher精确检验以及Kruskal-Wallis检验和事后Dunn检验进行统计分析。
在可分类癫痫患者的总样本中，合并性癫痫的患病率为1.56%。女性比男性更易患病（分别为67.7%和32.3%）。首先，在“短间隔”亚组（全身性发作和局灶性发作的时间间隔较短）与无其他脑部异常之间出现了具有统计学意义的关联；其次，在“长间隔”亚组（两种发作类型出现的时间间隔为4至37年）与存在其他脑部异常之间出现了具有统计学意义的关联（p = 0.02）。合并性癫痫组中癫痫家族史阳性的患者比例高于数据库中全身性癫痫组（p = 0.03）和局灶性癫痫组（p < 0.0001）。失神发作的电临床表型在合并性癫痫中比在数据库中的全身性失神癫痫患者中显示出更多非典型表现（提示预后不良）（p < 0.0001）。尽管患者选择和研究设计不同，但我们的主要发现与先前的研究一致。将合并性癫痫组细分为“长间隔”和“短间隔”亚组是一种新颖的方法，突出了每组不同的发病机制和临床关联。
这些病例报告可能有助于在医学界传播关于合并性癫痫的信息。在群体层面上对患者进行分析得出了具有临床实用价值的证据。
