Blum D E, Eskola J, Bortz J J, Fisher R S
Comprehensive Epilepsy Program, Barrow Neurological Institute, St.Joseph's Hospital & Medical Center, Phoenix, AZ 85013, USA.
Neurology. 1996 Jul;47(1):260-4. doi: 10.1212/wnl.47.1.260.
In 31 consecutive patients who were admitted to an epilepsy monitoring unit, we prospectively determined whether the patients were aware of having seizures. On admission, all patients stated that they knew of at least some of their seizures. Eight of 23 with classifiable epileptic seizures recognized that they were occasionally unaware of their seizures. During telemetry, following full recovery of consciousness after each seizure, we asked the patients whether they had recently had a seizure. For control purposes, we asked the patients the same question at random times. Among patients with seizures, there were no false-positive answers. Only 6 of 23 (26%) of the patients with epilepsy were always aware of their seizures, including complex partial and secondarily generalized events, and 7 of 23 (30%) were never aware of any seizures. Self-reporting of seizures was unreliable: Patients reporting the lowest baseline frequency of seizures had the highest fraction of unrecognized seizures. Seizure awareness was lowest for patients with temporal lobe foci, especially on the left side. Patients with primarily generalized epilepsy were more likely to be aware of tonic-clonic seizures than were patients with secondarily generalized partial seizures. All four patients with nonepileptic attacks believed that they always knew of their seizures, but only three of the four patients actually did always know. Unrecognized seizures are frequent and should be considered in patient management and in studies.
在连续收治入癫痫监测病房的31例患者中，我们前瞻性地确定患者是否知晓自己发生了癫痫发作。入院时，所有患者均表示至少知晓自己的一些癫痫发作情况。在23例可分类癫痫发作的患者中，有8例认识到自己偶尔意识不到癫痫发作。在遥测期间，每次癫痫发作后意识完全恢复时，我们询问患者是否最近发作过癫痫。为作对照，我们在随机时间向患者询问同样的问题。在有癫痫发作的患者中，没有假阳性回答。23例癫痫患者中只有6例（26%）总能意识到自己的癫痫发作，包括复杂部分性发作和继发性全身性发作，23例中有7例（30%）从未意识到任何癫痫发作。癫痫发作的自我报告不可靠：报告癫痫发作基线频率最低的患者未被识别的癫痫发作比例最高。颞叶病灶患者，尤其是左侧颞叶病灶患者，癫痫发作意识最低。原发性全身性癫痫患者比继发性全身性部分性癫痫患者更有可能意识到强直阵挛发作。所有4例非癫痫性发作患者均认为自己总能意识到发作，但4例患者中只有3例确实总能意识到。未被识别的癫痫发作很常见，在患者管理和研究中应予以考虑。
