Spencer S S, Spencer D D
Department of Neurology, Yale University School of Medicine, New Haven, Connecticut 06520-8018, USA.
Epilepsia. 1996 May;37(5):455-8. doi: 10.1111/j.1528-1157.1996.tb00591.x.
Where propagating symptomatic seizures terminate has not been studied, but might provide insight into mechanisms of seizure termination as well as localization of epileptogenic tissue. We investigated location of seizure termination in 50 refractory temporal lobe epilepsy (TLE) patients who had intracranial EEG recording of spontaneous seizures and subsequent temporal lobe resection with > 1-year follow-up. Only seizures that had onset in the resected temporal lobe were included. Location of the electrical termination for each seizure in each patient was categorized as diffuse, localized to the onset location, or localized elsewhere. The proportion of all seizures in each patient in each category was analyzed with respect to the outcome of surgery. Outcome was classified as seizure-free or persistent seizures. Diffuse seizure termination was noted equally frequently in both outcome groups. However, the 27 patients without seizures postoperatively had a significantly greater proportion of seizures with termination in the onset location (67%) than did the 23 patients with persistent seizures (36%, p < 0.01). The seizure-free patients also had a significantly lower proportion of seizures with localized termination elsewhere than the onset site (13%) than did patients with persistent seizures (45%, p < 0.005). Localization of the site of termination of seizures of focal origin to cortical regions other than the onset is associated with a poorer surgical prognosis. This observation raises the possibility of additional abnormal epileptogenic cortical regions with impaired seizure-terminating capabilities.
有症状的癫痫发作终止于何处尚未得到研究，但这可能有助于深入了解癫痫发作终止的机制以及致痫组织的定位。我们调查了50例难治性颞叶癫痫（TLE）患者癫痫发作终止的位置，这些患者进行了颅内脑电图记录自发性癫痫发作，并随后进行了颞叶切除术且随访时间超过1年。仅纳入在切除的颞叶开始发作的癫痫发作。将每位患者每次癫痫发作的电终止位置分类为弥漫性、局限于发作位置或局限于其他位置。分析了每位患者各类癫痫发作在手术结果方面的比例。结果分为无癫痫发作或持续性癫痫发作。在两个结果组中，弥漫性癫痫发作终止的频率相同。然而，术后无癫痫发作的27例患者癫痫发作终止于发作位置的比例（67%）显著高于有持续性癫痫发作的23例患者（36%，p<0.01）。无癫痫发作的患者癫痫发作终止于发作位置以外其他部位的比例（13%）也显著低于有持续性癫痫发作的患者（45%，p<0.005）。局灶性起源癫痫发作的终止部位定位于发作以外的皮质区域与较差的手术预后相关。这一观察结果提示存在额外的癫痫发作终止能力受损的异常致痫皮质区域的可能性。
