Hirsch L J, Lain A H, Walczak T S
Comprehensive Epilepsy Center, Department of Neurology, Columbia-Presbyterian Medical Center, New York, New York 10032, USA.
Epilepsia. 1998 Sep;39(9):991-7. doi: 10.1111/j.1528-1157.1998.tb01449.x.
We observed many patients with temporal lobe epilepsy (TLE) wiping their nose postictally, usually with the hand ipsilateral to their seizure focus. We wished to determine if this had lateralizing or localizing significance.
We retrospectively studied 87 patients: 47 with unilateral TLE defined by successful surgical outcome [30 with medial TLE (MTLE) and 17 with neocortical TLE (neoTLE)]; and 40 with extratemporal epilepsy (ExTLE). Videotapes of 319 complex partial seizures (CPS) without generalization were reviewed by 1 neurologist, blinded to patient identity, who recorded each episode of nosewiping and the hand with which it was performed.
With regard to localizing potential, postictal nosewiping (PINW) was significantly more common in patients with unilateral TLE than in those with ExTLE. In the TLE group, PINW within 60 s of electrographic seizure offset occurred in 60% of patients (28 of 47) and 43% of seizures (74 of 171). In the ExTLE group, PINW was noted in 33% of patients (13 of 40; p < 0.05 as compared with TLE) and 15% of seizures (22 of 148; p < 0.001). Similar results were obtained with PINW within 30 s of seizure offset. Although PINW was more frequent in MTLE than in neoTLE (67% of patients vs. 47%), this finding did not reach significance. With regard to lateralizing potential, in the TLE group, unilateral PINW (performed with a single hand only) within 60 s of seizure offset was observed in 53% of patients (25 of 47) and was performed with the hand ipsilateral to the seizure focus in 92% (23 of 25). Thirteen patients (9 with TLE) wiped their nose more than once with the same hand in a single seizure within 60 s of offset in 18 seizures; this was done with the hand ipsilateral to the seizure focus in all 18 instances (predictive value = 100%).
PINW is more common in unilateral TLE, particularly MTLE, than in ExTLE. PINW performed exclusively with one hand occurs in approximately 50% of patients with TLE and is highly predictive (92%) of seizure onset ipsilateral to the hand used, especially when it occurs repetitively. We hypothesize that ictal activation of the central autonomic nervous system, particularly the amygdala, results in ictal nasal secretions and causes nosewiping as the patient regains awareness postictally. The ipsilateral hand is used due to contralateral neglect or weakness.
我们观察到许多颞叶癫痫（TLE）患者在发作后擦鼻子，通常用与癫痫病灶同侧的手。我们希望确定这是否具有定位或定侧意义。
我们回顾性研究了87例患者：47例单侧TLE患者，其手术结果成功确定了癫痫灶位置[30例内侧颞叶癫痫（MTLE）和17例新皮质颞叶癫痫（neoTLE）]；以及40例颞叶外癫痫（ExTLE）患者。由1名对患者身份不知情的神经科医生查看319次无全面性发作的复杂部分性发作（CPS）的录像带，记录每次擦鼻事件及其所用的手。
关于定位潜力，发作后擦鼻（PINW）在单侧TLE患者中比在ExTLE患者中明显更常见。在TLE组中，60%的患者（47例中的28例）和43%的发作（171次中的74次）在脑电图发作结束后60秒内出现PINW。在ExTLE组中，33%的患者（40例中的13例）出现PINW（与TLE组相比，p<0.05），15%的发作（148次中的22次）出现PINW（p<0.001）。在发作结束后30秒内出现PINW也得到了类似结果。虽然PINW在MTLE中比在neoTLE中更频繁（67%的患者 vs. 47%），但这一发现未达到显著水平。关于定侧潜力，在TLE组中，53%的患者（47例中的25例）在发作结束后60秒内出现单侧PINW（仅用一只手），其中92%（25例中的23例）用与癫痫病灶同侧的手进行。13例患者（9例TLE患者）在发作结束后60秒内的18次发作中，用同一只手擦鼻不止一次；在所有18例中，均用与癫痫病灶同侧的手进行（预测价值 = 100%）。
PINW在单侧TLE，尤其是MTLE中比在ExTLE中更常见。约50%的TLE患者仅用一只手进行PINW，且对所用手同侧的癫痫发作起始具有高度预测性（92%），尤其是当反复出现时。我们推测，中枢自主神经系统，特别是杏仁核的发作期激活，导致发作期鼻部分泌物，并在患者发作后恢复意识时引起擦鼻。由于对侧忽视或无力，使用同侧手。
