Bernasconi A, Andermann F, Cendes F, Dubeau F, Andermann E, Olivier A
Montreal Neurological Institute and Hospital, McGill University, Quebec, Canada.
Neurology. 1998 Jun;50(6):1772-7. doi: 10.1212/wnl.50.6.1772.
To analyze clinical, electrophysiologic, and neuroradiologic characteristics and prognostic factors in a group of patients with temporal lobe epilepsy (TLE) and complex partial seizures (CPS) occurring exclusively or predominantly after they fall asleep or before they awaken.
CPS arising during sleep are classically identified with frontal lobe epilepsy. TLE associated with seizures occurring only or predominantly during sleep (nocturnal TLE) is less common.
From a series of patients with refractory TLE studied between 1980 and 1996, the authors identified 26 patients (15 men) with nonlesional nocturnal TLE (mean age, 40 years). Clinical and laboratory characteristics of these individuals were studied and compared with a group of 72 age-matched, randomly selected patients with nonlesional TLE and predominantly diurnal seizures (diurnal TLE).
Mean age at seizure onset was similar for both groups (16.3 versus 18.7 years). In the nocturnal TLE group, 2 of 26 patients had a positive family history of epilepsy, 18 reported an aura, 4 presented with CPS in clusters, 11 had unilateral and 15 bilateral temporal EEG abnormalities, and 14 of 21 studied had unilateral mesial temporal atrophy. None of these factors differed significantly in the two groups except for higher frequency of the following in the diurnal TLE group compared with the nocturnal TLE group: positive family history for epilepsy (33% versus 8%, p=0.01), estimated frequency of seizures (median, 14 versus 2 per month; p < 0.01), and presence of antecedent febrile convulsions (33% versus 11%, p=0.04). In the nocturnal TLE group, eight patients underwent surgical therapy and became seizure free (follow-up, > 12 months). Only two were seizure free on medication.
Infrequent and nonclustered seizures, rare family history of epilepsy, and low prevalence of childhood febrile convulsions characterize nocturnal TLE. Within the TLEs, the nocturnal TLE form seems to have a better surgical prognosis.
分析一组仅在入睡后或醒来前发作或主要在入睡后或醒来前发作的颞叶癫痫（TLE）和复杂部分性发作（CPS）患者的临床、电生理和神经放射学特征及预后因素。
睡眠中出现的CPS传统上被认为与额叶癫痫有关。仅在睡眠期间或主要在睡眠期间发作的TLE（夜间TLE）较少见。
在1980年至1996年间研究的一系列难治性TLE患者中，作者确定了26例（15例男性）无病变的夜间TLE患者（平均年龄40岁）。研究了这些个体的临床和实验室特征，并与一组72例年龄匹配、随机选择的无病变且主要为日间发作的TLE患者（日间TLE）进行比较。
两组的癫痫发作起始平均年龄相似（16.3岁对18.7岁）。在夜间TLE组中，26例患者中有2例有癫痫家族史阳性，18例报告有先兆，4例呈簇状发作CPS，11例有单侧颞叶脑电图异常，15例有双侧颞叶脑电图异常，21例接受研究的患者中有14例有单侧内侧颞叶萎缩。除了日间TLE组与夜间TLE组相比以下情况频率更高外，这些因素在两组中均无显著差异：癫痫家族史阳性（33%对8%，p = 0.01）、癫痫发作估计频率（中位数，每月14次对2次；p < 0.01）以及有热性惊厥史（33%对11%，p = 0.04）。在夜间TLE组中，8例患者接受了手术治疗且无癫痫发作（随访，> 12个月）。仅2例药物治疗后无癫痫发作。
发作不频繁且无簇状发作、癫痫家族史罕见以及儿童热性惊厥患病率低是夜间TLE的特征。在TLE中，夜间TLE形式似乎手术预后较好。
