Atalla N, Abou-Khalil B, Fakhoury T
Department of Neurology, Vanderbilt University, Nashville, Tennessee 37212, USA.
Electroencephalogr Clin Neurophysiol. 1996 Jan;98(1):9-13. doi: 10.1016/0013-4694(95)00210-3.
The start-stop-start (SSS) phenomenon is an apparent abortive ictal onset separated from the main seizure discharge. It was previously described in seizures recorded with subdural electrodes. We have observed this phenomenon in scalp-sphenoidal ictal recordings as well. We retrospectively reviewed 435 seizures recorded with scalp-sphenoidal electrodes from 61 patients with temporal lobe epilepsy. We found SSS onset in 15 seizures of 8 patients, representing 26% of these patients' seizures. The first "start" usually had a narrow field, typically in the sphenoidal electrode. The mean duration of the first "start" was 11 sec and that of the stop 8 sec. The restart had a different morphology and frequency in 87% and had a wider field in 67% of seizures. The clinical onset followed the first start and preceded the restart in most of the seizures. In 1 patient, 1 seizure with SSS was correctly localized and lateralized, whereas 5 of 7 without SSS were falsely lateralized. The recognition of the SSS phenomenon may improve the accuracy of seizure localization in scalp-sphenoidal recordings.
起始-终止-起始（SSS）现象是一种明显的发作性起始中断，与主要的癫痫放电分离。该现象先前在硬膜下电极记录的发作中被描述过。我们在头皮-蝶骨电极记录的发作中也观察到了这一现象。我们回顾性分析了61例颞叶癫痫患者头皮-蝶骨电极记录的435次发作。我们在8例患者的15次发作中发现了SSS起始，占这些患者发作的26%。第一次“起始”通常范围较窄，典型地出现在蝶骨电极处。第一次“起始”的平均持续时间为11秒，“终止”为8秒。在87%的发作中，再次起始具有不同的形态和频率，在67%的发作中范围更宽。在大多数发作中，临床发作跟随第一次起始并先于再次起始。在1例患者中，1次有SSS的发作被正确定位和定侧，而7次无SSS的发作中有5次被错误定侧。认识SSS现象可能会提高头皮-蝶骨电极记录中癫痫发作定位的准确性。
