Expanding the International Classification of Seizures to provide localization information
Expanding the International Classification of Seizures to provide localization information
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扩大缉获量的国际分类以提供本地化信息
DOI：
10.1212/wnl.43.9.1650
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发表时间：
1993
期刊：
影响因子：
9.9
通讯作者：
S. Noachtar
中科院分区：
文献类型：
--
作者：
H. Lüders;R. Burgess;S. Noachtar
1981年，国际抗癫痫联盟迈出了大胆的一步，引入了一种大大简化的癫痫发作分类，该分类后来成为普遍接受的国际癫痫发作分类（ICES）。这种分类采用双重二分法，一方面将癫痫发作分为全面性和部分性癫痫发作，然后根据在危急事件中意识是否丧失（或改变）或保留，将部分癫痫发作细分为“复杂”和“简单”部分癫痫发作。由于实际原因，对癫痫发作期间发生的事件失忆的患者也被认为遭受了严重的意识丧失（或至少有重大改变），因此被归类为“复杂”部分癫痫发作。与侧重于高度可变的癫痫症状的旧分类相比，ICES代表了一种重大的简化，即使是非专家也可以对癫痫发作进行正确的分类。对于药物治疗决策，“广义vs局部”和“简单vs复杂”的二分法实际上提供了关于选择药物的最基本信息。由于部分性癫痫发作对同一组抗惊厥药的反应或多或少相同，而与癫痫发作的起源部位无关，因此不需要对部分性癫痫发作进行详细的细分。另一方面，全身性癫痫发作往往需要不同的药物治疗取决于全身性癫痫发作的类型需要注意的是，ICES明确区分了对一种或另一种治疗有优先反应的不同类型的全身性癫痫发作2（例如，全身性强直性阵挛性癫痫发作与失神性癫痫发作），但没有区分发生于不同部位的复杂部分性癫痫发作（例如，发生于颞叶的精神运动性癫痫发作和发生于辅助运动区伴有意识丧失的强直性癫痫发作）。将部分性发作细分为“简单”和“复杂”，进一步强调了在许多情况下对癫痫患者的生活质量有重大影响的一个基本特征。具体来说，大多数不伴有意识丧失的部分性癫痫发作对患者的生活质量影响很小，而伴有意识丧失的部分性癫痫发作则明显干扰患者的生活。因此，在评估治疗是否成功时，从癫痫发作类型的角度仔细分析其影响是极其重要的，即复杂部分性癫痫发作的减少（其丰度往往直接影响生活质量）远比简单部分性癫痫发作频率的改变（其对生活质量影响不大）更有意义。这些考虑解释了为什么ICES几乎被世界各地的癫痫学家普遍接受：(1)简单而不考虑确切的症状，(2)与最佳药物治疗相关，(3)与生活质量有关。然而，在神经科医生评估癫痫患者的手术时，ICES不太受欢迎。对于局灶性癫痫的特征，许多人实际上继续使用经典的癫痫分类系统之一，该系统强调癫痫症状学，而不是关注意识的保存或改变。癫痫症状学给我们提供了重要的线索，以定位起病区和间接的癫痫发生区通过将部分发作分为简单和复杂，忽略了可用于定位癫痫发作区域的重要信息。由于这些缺点，有必要提出一种特殊的癫痫分类，以帮助那些有兴趣使用癫痫症状学作为定位癫痫区重要指标的人。这样的分类将与目前的ICES有根本的不同。在下面的段落中，我们将概述当前的局限性
In 1981, the International League Against Epilepsy took a bold step by introducing a greatly simplified seizure classification, which subsequently became the universally accepted International Classification of Epileptic Seizures (ICES). This classification employs a double dichotomy that divides the seizures into generalized and partial seizures on one side, and fur ther subdivides the par t ia l seizures into “complex” and “simple” par t ia l seizures depending on whether consciousness is lost (or altered) or preserved during the ictal event. For practical reasons, patients who were amnestic for the events occurring during the seizure are also considered to have suffered an ictal loss (or at least a significant alteration) of consciousness, and are therefore classified as having had a “complex” partial seizure.’ Compared with the older classification, which focused on the highly variable seizure symptomatology, the ICES represented a major simplification that permitted correct classification of seizures even by nonexperts. For pharmacologic treatment decisions, the dichotomies “generalized-versus-partial” and “simple-versus-complex” actually provide the most essential information regarding the drugs to select. Since partial seizures tend to respond more or less equally well to the same group of anticonvulsants independent of the site of origin of the seizure,2 no detailed subdivision of partial seizures is necessary. On the other hand, generalized seizures tend to require different pharmacologic treatments depending on the type of generalized seizure.2 Note that the ICES clearly differentiates between different types of generalized seizures that respond preferentially to one or another type of treatment2 (for example, generalized tonic-clonic seizures versus absence seizures), but does not distinguish complex partial seizures arising from different locations (for example, psychomotor seizures arising from the temporal lobe and tonic seizures with loss of consciousness arising from the supplementary motor area). The subdivision of partial seizures into “simple” and “complex” additionally emphasizes an essential characteristic that in many cases has significant repercussions on the quality of life of the epileptic patient. Specifically, most partial seizures without loss of consciousness have only a minor impact on the patient’s quali ty of life, whereas par t ia l seizures with loss of consciousness markedly disturb the patient’s life. Therefore, when evaluating the success of a treatment, it is extremely importan t to carefully analyze the impact from the standpoint of seizure type-ie, a decrease of complex partial seizures (whose abundance tends to directly affect the quality of life) is far more meaningful than a change in the frequency of simple partial seizures (which will have little effect on the quality of life). These considerations explain why the ICES has been almost universally accepted by epileptologists around the world: (1) simplicity irrespective of exact symptomatology, (2) correlation to optimal drug therapy, and (3) relationship to quality of life. However, the ICES has been less popular with neurologists evaluating epileptic patients for surgery. For characterizing focal seizures, many actually continue using one of the classic seizure classification systems, which stress seizure symptomatology as opposed to focusing on preservation or alteration of consciousness. Seizure symptomatology gives us important clues to the localization of the ictal onset zone and indirectly to the epileptogenic zone.3 Important information that can be used to localize the seizure onset zone is neglected by classifying partial seizures into merely simple and complex. Because of these shortcomings, it is logical to propose a special seizure classification for those interested in using seizure symptomatology as an important index of localization of the epileptogenic zone. Such a classification would differ fundamentally from the current ICES. In the following paragraphs, we will outline the limitations of the cur-