King D W, Smith J R
Department of Neurology, Medical College of Georgia, Augusta 30912, USA.
Adv Neurol. 1996;70:285-91.
Based on stimulation studies, observation of seizure phenomena in patients with epilepsy, and diagnostic studies documenting SSMA anatomic and functional abnormalities, there is evidence that epileptic involvement of the SSMA results in a set of clinical phenomena that include asymmetric tonic posturing of the extremities, abduction and elevation of the contralateral upper extremity, and speech arrest with preserved consciousness. Auras and vocalization occur less frequently. These seizures tend to be brief and to have an abrupt onset and cessation. They are more common during sleep than during wakefulness, and they tend to occur multiple times per night. The abolition of seizures following a resection limited to the SSMA provides conclusive evidence that the SSMA is the epileptogenic zone in some patients with this type of seizure. On the other hand, there is variation in seizure phenomena among patients whose seizures originate in the SSMA. In addition, there are patients with seizures suggestive of SSMA involvement whose seizures originate in a broad epileptogenic zone that includes the SSMA, other patients whose seizures originate outside the SSMA and spread to the SSMA, and still other patients whose seizures originate outside the SSMA and remain outside the SSMA. To better understand the phenomena associated with SSMA seizure onset and to determine the specificity of certain phenomena to SSMA involvement, additional data are needed from structural and functional imaging studies, video and EEG monitoring studies with noninvasive and invasive electrodes, and pathologic and surgical outcome studies. Since one cannot be certain at this time of the specificity of seizure phenomena to SSMA involvement, and because localization for possible surgery is the primary rationale for detailed study of these patients, we recommend that the term SSMA seizure refer only to those seizures that originate in the SSMA and that SSMA epilepsy refer only to epilepsies in which the patient's seizures originate in the SSMA. Since the present classification of epileptic seizures is not of value in describing the major phenomena of a partial seizure or in localization of the site of onset, a descriptive classification is needed to improve communication concerning seizure phenomena and to provide clues to localization.
基于刺激研究、对癫痫患者癫痫发作现象的观察以及记录补充运动区（SSMA）解剖和功能异常的诊断研究，有证据表明SSMA的癫痫累及会导致一系列临床现象，包括肢体不对称性强直姿势、对侧上肢外展和抬高以及意识保留的言语停顿。先兆和发声较少见。这些发作往往短暂，起病和停止突然。它们在睡眠期间比清醒时更常见，并且往往每晚发作多次。仅限于SSMA的切除术后癫痫发作消失，这提供了确凿证据，表明SSMA是某些此类发作患者的致痫区。另一方面，起源于SSMA的患者的癫痫发作现象存在差异。此外，有些癫痫发作提示SSMA受累的患者，其癫痫发作起源于包括SSMA在内的广泛致痫区；其他患者的癫痫发作起源于SSMA之外并扩散至SSMA；还有其他患者的癫痫发作起源于SSMA之外且仍局限于SSMA之外。为了更好地理解与SSMA癫痫发作起始相关的现象，并确定某些现象对SSMA受累的特异性，需要从结构和功能成像研究、使用无创和有创电极的视频和脑电图监测研究以及病理和手术结果研究中获取更多数据。由于目前尚不能确定癫痫发作现象对SSMA受累的特异性，并且由于可能的手术定位是详细研究这些患者的主要理由，我们建议术语“SSMA发作”仅指那些起源于SSMA的发作，而“SSMA癫痫”仅指患者癫痫发作起源于SSMA的癫痫。由于目前癫痫发作的分类对于描述部分性发作的主要现象或发作起始部位的定位没有价值，因此需要一种描述性分类来改善关于癫痫发作现象的交流，并提供定位线索。
