Does semiology tell us the origin of seizures consisting mainly of an alteration in consciousness?
Does semiology tell us the origin of seizures consisting mainly of an alteration in consciousness?
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DOI：
10.1111/j.1528-1167.2011.03126.x
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发表时间：
2011-08-01
期刊：
影响因子：
5.6
通讯作者：
Noachtar, Soheyl
中科院分区：
文献类型：
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作者：
Baykan, Betul;Altindag, Ebru;Noachtar, Soheyl
目的：对仅伴有意识改变的癫痫发作的研究主要局限于全身性癫痫。这种发作类型在局灶性癫痫中少见。我们的目的是在盲法设计中分析局灶性和广泛性癫痫中这种发作类型的符号学特征。方法：按符号学标准对100例患者338例癫痫发作录像进行分析。两名研究者从视频中评估了癫痫的符号学（先兆、癫痫持续时间、眨眼、轻度运动现象，包括自动性等）。在第二步中，主要是对脑电图研究和所有实验室结果进行评估，以定位癫痫区和描述综合征。重点发现：局灶性癫痫患者（n = 57）中，癫痫发生区可定位于颞叶区（n = 20）、额叶区（n = 9）和顶枕区（n = 3）。全身性癫痫患者（n = 43）最常见的病因可能是遗传（n = 33）。存在先兆（全身性癫痫无先兆，局灶性癫痫35%，p = 0.0008），缺乏眨眼（局灶性癫痫19.3%，全身性癫痫65.1%,p = 0.01），发作持续时间较长(全身性癫痫14.3 +/- 17.7 s，局灶性癫痫54.9 +/- 40.1 s；P < 0.0001)与局灶性癫痫显著相关，而高发作频率（P = 0.002）、癫痫家族史（P = 0.016）和对治疗的反应性（P = 0.004）表明是全面性癫痫。意义：以意识改变为主的癫痫发作可起源于局灶性癫痫的任何脑叶，也可发生于全身性癫痫。一些符号学和临床特征，有助于区分局灶性癫痫和全身性癫痫应考虑在综合征诊断。
Purpose: Studies on seizures only with an alteration of consciousness were limited mainly to generalized epilepsy. This seizure type has been described rarely in focal epilepsy. We aimed to analyze the semiologic features of this seizure type in focal and generalized epilepsies in a blinded design.Methods: A total of 338 seizure videos in 100 patients were included exclusively by semiologic criteria. Two investigators evaluated the seizure semiology (aura, seizure duration, blinking, mild motor phenomena including automatisms, and so on) from the videos. Primarily the ictal electroencephalography (EEGs) studies and all laboratory findings were evaluated for the localization of the epileptogenic zone and delineating the syndromes, in the second step.Key Findings: Of the focal epilepsy patients (n = 57), the epileptogenic zone could be localized to the temporal (n = 20), frontal (n = 9), and parietooccipital (n = 3) regions. The most common etiology of the generalized epilepsy patients (n = 43) was presumably genetic (n = 33). The presence of aura (none in generalized epilepsy vs. 35% in focal epilepsy; p = 0.0008), lack of blinking (19.3% in focal vs 65.1% in generalized epilepsy; p = 0.01), and longer seizure duration (generalized 14.3 +/- 17.7 s vs focal 54.9 +/- 40.1 s; p < 0.0001) are significantly associated with focal epilepsy, whereas high seizure frequency (p = 0.002), family history of epilepsy (p = 0.016), and responsiveness to therapy (p = 0.004) point to generalized epilepsy with logistic regression analysis.Significance: Seizures consisting mainly of an alteration in consciousness may originate from any brain lobe in focal epilepsies and also occur in generalized epilepsies. Several semiologic and clinical features that help to differentiate between focal and generalized epilepsy should be considered in the syndrome diagnosis.