Zappoli R, Zaccara G, Rossi L, Arnetoli G, Amantini A
Eur Neurol. 1983;22(3):192-204. doi: 10.1159/000115559.
A right-handed 32-year-old woman had recurrent combined partial temporal and secondary generalized epileptic states almost constantly related to menstruations. During such more or less prolonged episodes sometimes the patient presented right adversive attacks with short postictal dysphasia. The catamenial status epilepticus observed in this cas was manifested in two clear-cut behavioral phases. The first phase was characterized by frequently recurrent left temporal epileptiform discharges without tendency to diffusion, progressively more prolonged and pseudorhythmic associated with a signalized feeling of intense fear without apparent impairment of consciousness or speech disturbances. The electroclinical features of the first phase suggest a depth origin of the paroxysms, probably due to a primary epileptogenic focus in the left amygdaloid-hippocampal complex. In the second phase the left temporal focal semirhythmic discharges associated with fear bouts became more frequent and prolonged and began to be followed by long-lasting generalized discharges resulting in a trance-like state with severe impairment of consciousness. The diffuse paroxysmal activity regularly preceded by the left temporal focal discharges was interpreted as a form of secondary bilateral synchrony constantly triggered from a focal pacemaker represented by the primary epileptogenic focus. During the very short transient periods of sudden cessation of the epileptiform activity the patient returned immediately to an apparent normal mental state. Good correlation could be established between different seizure patterns and predominant clinical signs. Intravenous diazepam rapidly decreased and then completely stopped the catamenial status epilepticus. Some problems related to the classification of these rare epileptic events are discussed.
一名32岁右利手女性几乎持续出现与月经相关的复发性颞叶部分性发作合并继发性全身性癫痫状态。在这些或多或少持续较长时间的发作期间，患者有时会出现右侧偏斜发作，并伴有短暂的发作后言语困难。该病例中观察到的经期癫痫持续状态表现为两个明确的行为阶段。第一阶段的特征是左侧颞叶癫痫样放电频繁复发，无扩散倾向，逐渐延长且呈假性节律性，伴有强烈恐惧的明显感觉，意识或言语无明显受损。第一阶段的电临床特征提示发作起源于深部，可能是由于左侧杏仁核 - 海马复合体存在原发性致痫灶。在第二阶段，与恐惧发作相关的左侧颞叶局灶性半节律性放电变得更加频繁和延长，并开始继发持久的全身性放电，导致意识严重受损的恍惚状态。由左侧颞叶局灶性放电规律前驱的弥漫性阵发性活动被解释为继发性双侧同步的一种形式，不断由以原发性致痫灶为代表的局灶性起搏器触发。在癫痫样活动突然停止的极短瞬态期间，患者立即恢复到明显正常的精神状态。不同发作模式与主要临床体征之间可建立良好的相关性。静脉注射地西泮迅速减轻并随后完全终止了经期癫痫持续状态。文中讨论了与这些罕见癫痫事件分类相关的一些问题。
