Bleasel A, Kotagal P, Kankirawatana P, Rybicki L
Section of Epilepsy & Sleep Disorders, Cleveland Clinic Foundation, OH 44195, USA.
Epilepsia. 1997 Feb;38(2):168-74. doi: 10.1111/j.1528-1157.1997.tb01093.x.
Unilateral dystonic limb posturing in partial seizures has been shown to be an accurate lateralizing sign indicating seizure onset in the contralateral hemisphere. However, its clinical utility may be reduced by confusion with other lateralized ictal motor phenomena. In this study, the ictal phenomena of dystonic limb posturing, tonic limb posturing, unilateral immobile limb, and version were distinguished and examined in patients with temporal and extratemporal seizures.
Partial seizures in 54 patients, successfully treated by surgery (34 temporal, 20 extratemporal; 14 frontal, 3 parietal, and 3 occipital), were analyzed blindly by 3 reviewers. Interobserver agreement was tested with kappa indexes and positive predictive value (PPV) was determined for each sign.
In patients with temporal lobe epilepsy (TLE), dystonic posturing occurred in 35.3% (kappa 0.78, positive predictive value (PPV) for the sign being contralateral to seizure onset 92%); tonic limb posturing occurred in 17.7% (kappa 0.36, PPV 40%); unilateral immobile limb occurred in 11.8% (kappa 0.23, PPV 100%); and version occurred in 35.3% (kappa 0.77, PPV 100%). In patients with extratemporal epilepsy, dystonic posturing occurred in 20.0% (kappa 0.31, PPV 100%); tonic limb posturing occurred in 15.0% (kappa 0.08, PPV 67%); and version occurred in 40.0% (kappa 0.54, PPV 100%). The higher kappa indexes were significant for dystonic posturing (p < 0.001) and tonic limb posturing (p = 0.032) in TLE. Dystonic posturing (p = 0.034), tonic posturing (p = 0.07), and version (p = 0.0038) occurred earlier in extratemporal seizures than in temporal seizures.
Of the limb ictal motor phenomena, only dystonic posturing was accurate and had good interobserver agreement.
部分性癫痫发作时的单侧肌张力障碍性肢体姿势已被证明是一种准确的定侧体征，表明对侧半球为癫痫发作起始部位。然而，与其他定侧性发作期运动现象相混淆可能会降低其临床实用性。在本研究中，对颞叶和颞叶外癫痫患者的肌张力障碍性肢体姿势、强直性肢体姿势、单侧肢体静止和眼球偏转等发作期现象进行了区分和研究。
由3名评估者对54例成功接受手术治疗的部分性癫痫患者（34例颞叶癫痫，20例颞叶外癫痫；14例额叶癫痫，3例顶叶癫痫和3例枕叶癫痫）进行盲法分析。用kappa指数检验观察者间的一致性，并确定每个体征的阳性预测值（PPV）。
在颞叶癫痫（TLE）患者中，肌张力障碍性姿势发生率为35.3%（kappa值0.78，该体征对侧为癫痫发作起始部位的阳性预测值（PPV）为92%）；强直性肢体姿势发生率为17.7%（kappa值0.36，PPV为40%）；单侧肢体静止发生率为11.8%（kappa值0.23，PPV为100%）；眼球偏转发生率为35.3%（kappa值0.77，PPV为100%）。在颞叶外癫痫患者中，肌张力障碍性姿势发生率为20.0%（kappa值0.31，PPV为100%）；强直性肢体姿势发生率为15.0%（kappa值0.08，PPV为67%）；眼球偏转发生率为40.0%（kappa值0.54，PPV为100%）。较高的kappa指数在TLE患者的肌张力障碍性姿势（p < 0.001）和强直性肢体姿势（p = 0.032）方面具有显著意义。颞叶外癫痫发作时，肌张力障碍性姿势（p = 0.034）、强直性姿势（p = 0.07）和眼球偏转（p = 0.0038）比颞叶癫痫发作更早出现。
在肢体发作期运动现象中，只有肌张力障碍性姿势是准确的，且观察者间一致性良好。
