Oane Irina, Barborica Andrei, Mîndruţă Ioana
Neurology Department, Epilepsy Monitoring Unit, University Emergency Hospital Bucharest, Bucharest, Romania.
Physics Department, University of Bucharest, Bucharest, Romania.
Epileptic Disord. 2025 Apr;27(2):171-186. doi: 10.1002/epd2.20328. Epub 2024 Dec 26.
We performed a systematic review of the ictal semiology of temporo-frontal seizures with the aim to summarize the state-of-the-art anatomo-clinical correlations in the field, and help guide the interpretation of ictal semiology within the framework of presurgical evaluation. We conducted the systematic review and meta-analysis, and reported its results according to the Preferred Reporting Items for Systematic Review and Meta-Analysis statement. We searched electronic databases (Scopus, PUBMED, Web of Science, and EMBASE) using relevant keywords related to temporal, frontal and sublobar structures, semiology, and electroencephalography/stereoelectroencephalography exploration. The risk of bias was evaluated using the QUADAS2. We included articles in English, reporting the seizure semiology of patients with temporal lobe epilepsy with temporal-frontal involvement and patients with frontal lobe epilepsy and fronto-temporal network involved. We performed hierarchical cluster analysis to determine signs and symptoms associated with the temporo-frontal epileptogenic network for all patients and for each subgroup (frontal/temporal seizure onset). Fisher exact test was performed to evaluate the difference in seizure freedom and clinical sign/symptom occurrence in patients that underwent unilobar versus bilobar resection. Meta-analysis on the prevalence of temporo-frontal/fronto-temporal involvement applying a random-effect model was used. We included 40 articles and we extracted data from 109 patients. The meta-analysis showed the total prevalence of temporo-frontal/fronto-temporal network involvement was 19.75%, CI 12.02-27.47, high heterogeneity (82.71%). For the whole group and subgroups, the main cluster of clinical manifestations is emotional, autonomic, cognitive, grimace, hyperkinetic (association coefficient higher than .6). Elementary motor semiology is significantly associated with multilobar resection (p = .022 whole group and p = .0012 fronto-temporal subgroup). Fifty-eight patients were seizure-free after surgery. There was no significant difference between seizure freedom in uni versus bilobar resections (p = .28). Seizures involving temporo-frontal/fronto-temporal network usually manifest with a cluster of signs and symptoms: emotional, autonomic, grimace, cognitive and hyperkinetic behavior. Based on semiology, one cannot distinguish between fronto-temporal and temporo-frontal cases at individual patient level. In those patients undergoing a surgical procedure, elementary motor seizure semiology is significantly associated with multilobar resection.
我们对颞叶-额叶癫痫发作的发作期症状学进行了系统综述，目的是总结该领域最新的解剖学-临床相关性，并在术前评估框架内帮助指导对发作期症状学的解读。我们进行了系统综述和荟萃分析，并根据系统综述和荟萃分析报告的首选项目报告了结果。我们使用与颞叶、额叶和叶下结构、症状学以及脑电图/立体脑电图探索相关的关键词搜索了电子数据库（Scopus、PUBMED、科学网和EMBASE）。使用QUADAS2评估偏倚风险。我们纳入了英文文章，报告了颞叶-额叶受累的颞叶癫痫患者以及额叶癫痫和额颞叶网络受累患者的发作症状学。我们进行了层次聚类分析，以确定所有患者以及每个亚组（额叶/颞叶发作起始）与颞叶-额叶致痫网络相关的体征和症状。进行Fisher精确检验以评估单叶切除与双叶切除患者在无癫痫发作和临床体征/症状出现方面的差异。使用随机效应模型对颞叶-额叶/额颞叶受累的患病率进行荟萃分析。我们纳入了40篇文章，并从109例患者中提取了数据。荟萃分析显示，颞叶-额叶/额颞叶网络受累的总患病率为19.75%，置信区间为12.02 - 27.47，异质性高（82.71%）。对于整个组和亚组，主要的临床表现集群是情感、自主神经、认知、鬼脸、多动（关联系数高于0.6）。基本运动症状学与多叶切除显著相关（全组p = 0.022，额颞叶亚组p = 0.0012）。58例患者术后无癫痫发作。单叶切除与双叶切除在无癫痫发作方面无显著差异（p = 0.28）。涉及颞叶-额叶/额颞叶网络的癫痫发作通常表现为一系列体征和症状：情感、自主神经、鬼脸、认知和多动行为。基于症状学，在个体患者层面无法区分额颞叶和颞叶-额叶病例。在那些接受手术的患者中，基本运动性癫痫发作症状学与多叶切除显著相关。
