Gilmore R L, Childress M D, Leonard C, Quisling R, Roper S, Eisenschenk S, Mahoney M
Department of Neurology, College of Medicine, University of Florida, Gainesville, USA.
Arch Neurol. 1995 Aug;52(8):819-24. doi: 10.1001/archneur.1995.00540320103017.
To determine whether the occurrence of hippocampal formation (HF) volumetric asymmetry can reliably discriminate between complex partial seizures (CPSs) of a temporal lobe origin and CPSs of an extra-temporal lobe origin in a prospective study of patients with intractable CPSs (approximately 70% of patients have electrographic foci in the temporal lobe [HF volumetric asymmetry on magnetic resonance imaging scans has been shown to lateralize such foci reliably)].
We examined HF volumetrics on magnetic resonance imaging scans that were acquired with a 1-T magnetic resonance imaging scanner (Siemens Magnetom, Siemens Medical Systems, Iselin, NJ) by using magnetization-prepared rapid gradient echo three-dimensional sequences (producing a gapless series of high-contrast 1.25-mm images). These data were compared with ictal, interictal, invasive, and noninvasive videoelectroencephalographic monitoring data, functional imaging data, and outcome data to define each patient's type of epilepsy.
Forty-one patients were recruited from a tertiary university comprehensive epilepsy program, and 22 control subjects were recruited from the neurologically normal university community.
Among the control subjects, the difference in HF volumetrics (right-left HF volumetrics) was + 0.085 +/- 0.253 cm3. Of the 41 patients, 25 had temporal lobe epilepsy. When we set the upper limit of normal at the mean +/- 3 SDs, all patients beyond the upper limit had CPSs of a temporal lobe origin. Of the patients with temporal lobe epilepsy, only three fell within normal limits. No patient with CPSs of an extratemporal lobe origin fell beyond the upper limit.
The presence of significant HF volumetric asymmetry makes it highly unlikely that a patient's CPSs are of an extratemporal lobe origin.
在一项针对难治性复杂部分性发作（CPS）患者的前瞻性研究中（约70%的患者脑电图病灶位于颞叶[磁共振成像扫描显示海马结构（HF）体积不对称可可靠地使此类病灶定位]），确定海马结构体积不对称的出现是否能可靠地区分颞叶起源的复杂部分性发作和颞叶外起源的复杂部分性发作。
我们使用1-T磁共振成像扫描仪（西门子Magnetom，西门子医疗系统公司，新泽西州伊斯林），通过磁化准备快速梯度回波三维序列（生成一系列无间隙的高对比度1.25毫米图像），对磁共振成像扫描的HF体积进行了检查。将这些数据与发作期、发作间期、侵入性和非侵入性视频脑电图监测数据、功能成像数据及转归数据进行比较，以确定每位患者的癫痫类型。
从一所大学三级综合癫痫项目中招募了41例患者，从神经功能正常的大学社区招募了22名对照者。
在对照者中，HF体积差异（右侧-左侧HF体积）为+0.085±0.253 cm³。41例患者中，25例患有颞叶癫痫。当我们将正常上限设定为平均值±3个标准差时，所有超出上限的患者均有颞叶起源的CPS。在颞叶癫痫患者中，只有3例在正常范围内。没有颞叶外起源的CPS患者超出上限。
存在明显的HF体积不对称极不可能使患者的CPS为颞叶外起源。
