Tassinari C A, Bureau-Paillas M, Dalla Bernardina B, Picornell-Darder I, Mouren M C, Dravet C, Roger J
Rev Electroencephalogr Neurophysiol Clin. 1978 Jan-Mar;8(1):107-22. doi: 10.1016/s0370-4475(78)80126-9.
On the basis of 21 personal observations as well as those (82) from the litterature, it is concluded that the progressive myoclonic epilepsy with Lafora bodies (P.M.E.) constitutes a disease on its own. The clinical features are those described in the litterature observations and completed by some characteristics; the high frequency of visual symptoms (47 p. 100 personal cases); the relatively less bad evolution of epilepsy, perhaps in relation with use of modern drugs; the relatively moderate intensity of myoclonus which becomes complete only at the end of the evolution. From E.E.G. point of view, we can distinguish three periods: an initial one at the very onset of disease, who will show the same features as observated in primary generalized epilepsy, i.e. a well preserved background activity with superimposed generalized fast spikes and waves facilitated by the I.L.S. Then follows a period of evolutive E.E.G. (1-2 years after the onset of the disease) characterized by progressive slowing of the posterior background, enlargement of posterior slow activity and appearance of diffuse theta and delta activity. Simultaneously spikes and waves are taking less typical and bisynchronous aspect. Finally after 3 to 5 years from the onset there is a diffusely slow E.E.G. with superimposed fast multiple spikes. The E.E.G. findings in litterature usually refer only to this last period (stationary or terminal period). Occipital independent multiple spikes are frequently observed and could correlate with the visual symptoms observated in the Lafora disease. Some elements of differential diagnosis are given with respect to primary generalized epilepsy at the onset of the disease and later on with respect to dyssynergia cerebellaris myoclonica and to the progressive myoclonic epilepsy without Lafora bodies.
基于21例个人观察病例以及文献中的82例病例,得出结论:伴有拉福拉小体的进行性肌阵挛癫痫(P.M.E.)本身构成一种疾病。临床特征与文献观察中所描述的一致,并补充了一些特点;视觉症状出现频率高(个人病例中占47%);癫痫的病情进展相对较好,可能与现代药物的使用有关;肌阵挛强度相对适中,仅在病程后期才完全出现。从脑电图(EEG)角度来看,可区分三个阶段:疾病刚发作时的初始阶段,其表现与原发性全身性癫痫观察到的特征相同,即背景活动保存良好,伴有叠加的全身性快速棘波和慢波,经光刺激强化(ILS)。随后是脑电图演变阶段(疾病发作后1 - 2年),其特征是后部背景逐渐变慢,后部慢波活动增强,出现弥漫性θ波和δ波活动。同时,棘波和慢波的形态变得不那么典型且不同步。最后,在疾病发作3至5年后,脑电图表现为弥漫性慢波,并叠加有多个快速棘波。文献中的脑电图研究结果通常仅涉及这最后一个阶段(静止期或终末期)。枕叶独立多棘波经常被观察到,可能与拉福拉病中观察到的视觉症状相关。文中给出了疾病发作时与原发性全身性癫痫以及后期与肌阵挛性小脑协同失调和无拉福拉小体的进行性肌阵挛癫痫的一些鉴别诊断要点。