Blum D
Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ 85013.
Electroencephalogr Clin Neurophysiol. 1994 Nov;91(5):329-36. doi: 10.1016/0013-4694(94)90120-1.
Most patients with partial seizures of temporolimbic onset have predominantly unilateral seizure foci, which partly accounts for the success of unilateral temporal lobectomy. The prevalence of bilateral foci is not known. "Discordant" seizures are those which arise from the contralateral side from the usual focus. "Concordance" is the fraction of seizures which arise from the majority side, ranging from 0.5 to 1.0. From observations of seizures recorded in an epilepsy monitoring unit, a model of the patient population can be determined by non-linear least squares methods. Six hundred and five seizures from 57 consecutive patients with non-lesional temporolimbic epilepsy were studied. In the model population, 15% of patients have concordance of less than 70%, and 80% have concordance > 90%. Using Bayes' theorem, the observation of 5 concordant seizures implies a 95% chance of the patient having a concordance of at least 90%. If one discordant seizure is recorded, then to reach the 95% confidence level of 90% concordance requires a total of 11 concordant seizures. For the smaller group of patients with strictly unilateral interictal spikes, only 4 concordant seizures need to be recorded to achieve the same level of confidence of unilaterality. Interpretation of telemetry studies requires knowledge of the patient population.
大多数颞叶内侧起始的部分性癫痫患者主要有单侧癫痫病灶，这部分解释了单侧颞叶切除术的成功原因。双侧病灶的患病率尚不清楚。“不一致性”癫痫是指起源于与通常病灶对侧的癫痫发作。“一致性”是指起源于主要侧的癫痫发作比例，范围从0.5到1.0。通过对癫痫监测单元记录的癫痫发作进行观察，可以用非线性最小二乘法确定患者群体的模型。对57例连续的非病变性颞叶内侧癫痫患者的605次癫痫发作进行了研究。在模型群体中，15%的患者一致性低于70%，80%的患者一致性>90%。使用贝叶斯定理，观察到5次一致性癫痫发作意味着患者有95%的可能性一致性至少为90%。如果记录到1次不一致性癫痫发作，那么要达到90%一致性的95%置信水平则总共需要11次一致性癫痫发作。对于严格单侧发作间期棘波的较小患者群体，只需记录4次一致性癫痫发作就能达到相同的单侧性置信水平。对遥测研究的解释需要了解患者群体情况。
