Steinhoff B J, Schindler M, Herrendorf G, Kurth C, Bittermann H J, Paulus W
Department of Clinical Neurophysiology, Georg-August University, Göttingen, Germany.
Eur Neurol. 1998;39(2):72-9. doi: 10.1159/000007913.
In order to assess the lateralizing value of several ictal and postictal clinical symptoms in temporal lobe epilepsy (TLE), we analyzed 89 seizures of 20 left dominant patients with intractable left (n = 9) versus right (n = 11) TLE who had undergone successful anterior temporal lobectomy. In left TLE, movement arrest at seizure onset, postictal dysphasia > 120 s and postictal dyslexia > 180 s were the most typical findings and associated with a sensitivity of 94, 94, and 100%, respectively. The highest specificity of 100% each was evident for contralateral versions of eyes and head and dystonic posturing. In right TLE, the highest sensitivity was seen for whole-body movements at seizure onset, postictal dysphasia < 120 s and postictal dyslexia < 180 s with figures of 82, 87, and 93%, respectively. As compared to left TLE, contralateral version and dystonic posturing, ictal speech, and postictal dyslexia < 180 s each had a specificity of 100%. The careful combined analysis of certain ictal clinical signs combined with consistent findings of interictal EEG and neuroimaging studies may be often sufficient to proceed with epilepsy surgery without invasive recordings even if ictal scalp EEG is not unambiguous.
为了评估几种发作期和发作后期临床症状在颞叶癫痫（TLE）中的定侧价值，我们分析了20例左侧优势半球、难治性左侧（n = 9）和右侧（n = 11）TLE患者的89次发作，这些患者均成功接受了前颞叶切除术。在左侧TLE中，发作起始时的运动停止、发作后期言语困难> 120秒和发作后期阅读障碍> 180秒是最典型的表现，其敏感性分别为94%、94%和100%。对侧眼球和头部转动以及张力障碍性姿势的特异性最高，均为100%。在右侧TLE中，发作起始时的全身运动、发作后期言语困难< 120秒和发作后期阅读障碍< 180秒的敏感性最高，分别为82%、87%和93%。与左侧TLE相比，对侧转动和张力障碍性姿势、发作期言语以及发作后期阅读障碍< 180秒的特异性均为100%。即使发作期头皮脑电图不明确，仔细综合分析某些发作期临床体征，并结合发作间期脑电图和神经影像学研究的一致结果，通常也足以在不进行侵入性记录的情况下开展癫痫手术。
