Foldvary N, Lee N, Thwaites G, Mascha E, Hammel J, Kim H, Friedman A H, Radtke R A
Division of Neurology, Duke University Medical Center, Durham, NC, USA.
Neurology. 1997 Sep;49(3):757-63. doi: 10.1212/wnl.49.3.757.
To determine whether lesional neocortical temporal lobe epilepsy (NTLE) can be differentiated from mesial temporal lobe epilepsy (MTLE) during the noninvasive presurgical evaluation, we compared the historical features, seizure symptomatology, and surface EEG of 8 patients seizure free after neocortical temporal resection with preservation of mesial structures and 20 patients after anterior temporal lobectomy for MTLE. Seizure symptomatology of 107 seizures (28 NTLE, 79 MTLE) was analyzed. One hundred one ictal EEGs (19 NTLE, 82 MTLE) were reviewed for activity at seizure onset; presence, distribution, and frequency of lateralized rhythmic activity (LRA); and distribution of postictal slowing. Seizure symptomatology and EEG data were compared between groups, and sensitivity, specificity, and positive and negative predictive values were determined for variables that differed significantly. Multiple logistic regression was used to determine whether patients could be correctly classified as having MTLE or NTLE. MTLE patients were younger at onset of habitual seizures and more likely to have a prior history of febrile seizures, CNS infection, perinatal complications, or head injury. NTLE seizures lacked features commonly exhibited in MTLE, including automatisms, contralateral dystonia, searching head movements, body shifting, hyperventilation, and postictal cough or sigh. NTLE ictal EEG recordings demonstrated lower mean frequency of LRA that frequently had a hemispheric distribution, whereas LRA in MTLE seizures was maximal over the ipsilateral temporal region. We conclude that it may be possible to differentiate lesional NTLE from MTLE on the basis of historical features, seizure symptomatology, and ictal surface EEG recordings. This may assist in the identification of patients with medically refractory nonlesional NTLE who frequently require intracranial monitoring and more extensive or tailored resections.
为了确定在无创术前评估期间，病灶性新皮质颞叶癫痫（NTLE）是否能够与内侧颞叶癫痫（MTLE）相鉴别，我们比较了8例在保留内侧结构的情况下接受新皮质颞叶切除术后无癫痫发作的患者以及20例接受前颞叶切除术治疗MTLE的患者的病史特征、癫痫发作症状学和头皮脑电图。分析了107次癫痫发作（28次NTLE，79次MTLE）的发作症状学。回顾了101份发作期脑电图（19份NTLE，82份MTLE），以观察发作起始时的活动情况、侧化节律性活动（LRA）的存在、分布和频率以及发作后慢波的分布。比较了两组之间的癫痫发作症状学和脑电图数据，并确定了有显著差异的变量的敏感性、特异性以及阳性和阴性预测值。采用多因素逻辑回归来确定患者是否能够被正确分类为患有MTLE或NTLE。MTLE患者习惯性癫痫发作的起始年龄较小，并且更有可能有热性惊厥、中枢神经系统感染、围产期并发症或头部损伤的既往史。NTLE发作缺乏MTLE中常见的特征，包括自动症、对侧肌张力障碍、头部搜寻动作、身体移动、过度换气以及发作后咳嗽或叹息。NTLE发作期脑电图记录显示LRA的平均频率较低，且常呈半球分布，而MTLE发作中LRA在同侧颞区最为明显。我们得出结论，基于病史特征、癫痫发作症状学和发作期头皮脑电图记录，有可能将病灶性NTLE与MTLE区分开来。这可能有助于识别那些经常需要进行颅内监测以及更广泛或针对性切除的药物难治性非病灶性NTLE患者。
