O'Brien T J, Kilpatrick C, Murrie V, Vogrin S, Morris K, Cook M J
Royal Melbourne Hospital, Australia.
Brain. 1996 Dec;119 ( Pt 6):2133-41. doi: 10.1093/brain/119.6.2133.
This study aims to determine whether there are important clinico-electrical differences between patients with temporal lobe epilepsy (TLE) secondary to mesial temporal sclerosis (MTS) and those with TLE secondary to a discrete temporal neocortical lesion (NL). The case histories, interictal EEG, seizure semiology, ictal EEG and postoperative outcome of 46 pathologically proven patients (31 MTS and 15 NL) were compared. A history of febrile convulsions (FC) was more common in MTS patients (58% versus 26%, P < 0.05), as was a history of a significant cerebral event at < 4 years of age (22% versus 0%, P < 0.05). There were no statistically significant differences in the incidence or nature of auras. No statistically significant differences between the groups were found in the interictal-EEG. With ictal semiology dystonic posturing occurred more frequently in MTS patients (mean 52% versus 26%, P < 0.05). Facial grimacing/ twitching occurred earlier in the seizures of NL patients (median 19 s versus 35 s, P < 0.05). There was an increased frequency of fast rhythmic sharp waves (> 4 Hz) in the ictal-EEG of MTS patients (mean 81% versus 60%, P = 0.05). The patients with NL developed bilateral ictal EEG changes more often (mean 55% versus 26%, P < 0.05) and more rapidly (mean 23 s versus 74 s, P < 0.005). The onset of ictal EEG seizure activity was bilateral more often in patients with NL (20% versus 4%, P < 0.005). There were no significant differences between the two groups for any of the video-EEG features, in terms of whether or not the feature occurred at least once in an individual patients. There was a tendency for MTS patients to have a higher seizure-free postsurgical outcome (87% versus 60%, P = 0.057). However, all the NL patients who were not free of seizures had had an incomplete lesion resection. We conclude that there are a number of clinico-electrical differences between patients with mesial TLE (MTLE) and patients with neocortical TLE (NCTLE), but that none of these are sufficient to allow a distinction to be made in an individual patient.
本研究旨在确定内侧颞叶硬化（MTS）继发的颞叶癫痫（TLE）患者与离散性颞叶新皮质病变（NL）继发的TLE患者之间是否存在重要的临床-电生理差异。比较了46例经病理证实的患者（31例MTS和15例NL）的病史、发作间期脑电图、发作症状学、发作期脑电图及术后结果。热性惊厥（FC）病史在MTS患者中更为常见（58%对26%，P<0.05），4岁前有重大脑事件病史的情况也是如此（22%对0%，P<0.05）。先兆的发生率或性质无统计学显著差异。两组在发作间期脑电图方面未发现统计学显著差异。在发作症状学方面，张力障碍姿势在MTS患者中更频繁出现（平均52%对26%，P<0.05）。面部 grimacing/抽搐在NL患者的发作中出现得更早（中位数19秒对35秒，P<0.05）。MTS患者发作期脑电图中快节律锐波（>4Hz）的频率增加（平均81%对60%，P=0.05）。NL患者发作期脑电图出现双侧改变的情况更频繁（平均55%对26%，P<0.05）且更快（平均23秒对74秒，P<0.005）。NL患者发作期脑电图癫痫活动的起始更常为双侧性（20%对4%，P<0.005）。就某一视频脑电图特征在个体患者中是否至少出现一次而言，两组在任何视频脑电图特征方面均无显著差异。MTS患者术后无发作的结局有更高的趋势（87%对60%，P=0.057）。然而，所有仍有发作的NL患者均存在病变切除不完全的情况。我们得出结论，内侧颞叶癫痫（MTLE）患者和新皮质颞叶癫痫（NCTLE）患者之间存在一些临床-电生理差异，但这些差异均不足以在个体患者中进行区分。
