Serles W, Pataraia E, Bacher J, Olbrich A, Aull S, Lehrner J, Leutmezer F, Deecke L, Baumgartner C
Universitätsklinik für Neurologie, Vienna, Austria.
Neurology. 1998 Mar;50(3):742-7. doi: 10.1212/wnl.50.3.742.
To compare the reliability of clinical seizure lateralization in temporal lobe epilepsy patients with unitemporal and bitemporal independent interictal spikes and unilateral hippocampal atrophy or sclerosis (HA/HS) on MRI scan.
We studied 11 patients with unitemporal and 10 patients with bitemporal interictal spikes. We calculated a spike ratio by dividing the number of spikes ipsilateral to the side of HA/HS by those occurring contralaterally.
Clinical seizure lateralization was correct, i.e., ipsilateral to the side of HA/HS, significantly more often in the unitemporal group. Spike ratios were significantly higher in seizures that were lateralized correctly as compared with both incorrectly and nonlateralized seizures. Within the individual patients, a significant positive correlation between spike ratios and the proportion of correctly lateralized seizures was found. We identified three categories of symptoms according to lateralization accuracy. Category 1 symptoms (version, postictal paresis, and early ictal vomiting/retching) lateralized to the side of HA/HS in 100% of patients in the uni- and bitemporal groups. Category 2 symptoms (dystonic posturing, mouth deviation, postictal dysnomia/dysphasia, and ictal speech) provided a 100% correct lateralization in the unitemporal but not in the bitemporal patients. Category 3 symptoms (nonversive early head turning and unilateral upper extremity automatisms) yielded erroneous lateralization in both patient groups.
We conclude that reliable clinical seizure lateralization in mesial temporal lobe epilepsy can only be achieved in patients with unitemporal interictal spikes, whereas clinical lateralization in patients with bitemporal spikes must be viewed cautiously.
比较颞叶癫痫患者单颞叶和双颞叶独立发作间期棘波以及MRI扫描显示单侧海马萎缩或硬化（HA/HS）时临床发作定侧的可靠性。
我们研究了11名单颞叶发作间期棘波患者和10名双颞叶发作间期棘波患者。我们通过将HA/HS侧同侧的棘波数量除以对侧出现的棘波数量来计算棘波比率。
临床发作定侧正确，即与HA/HS侧同侧，在单颞叶组中显著更常见。与定侧错误和不定侧的发作相比，正确定侧的发作中棘波比率显著更高。在个体患者中，发现棘波比率与正确定侧发作的比例之间存在显著正相关。根据定侧准确性，我们确定了三类症状。第1类症状（眼球偏转、发作后轻瘫以及发作早期呕吐/干呕）在单颞叶和双颞叶组中100%的患者定侧于HA/HS侧。第2类症状（张力障碍姿势、口角偏斜、发作后命名障碍/失语以及发作期言语）在单颞叶患者中定侧100%正确，但在双颞叶患者中并非如此。第3类症状（非旋转性早期头部转动和单侧上肢自动症）在两组患者中均产生错误定侧。
我们得出结论，内侧颞叶癫痫患者中，只有单颞叶发作间期棘波的患者才能实现可靠的临床发作定侧，而双颞叶棘波患者的临床定侧必须谨慎看待。
