Lateralizing value and semiology of ictal limb posturing and version in temporal lobe and extratemporal epilepsy
Lateralizing value and semiology of ictal limb posturing and version in temporal lobe and extratemporal epilepsy
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DOI：
10.1111/j.1528-1157.1997.tb01093.x
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发表时间：
1997-02-01
期刊：
影响因子：
5.6
通讯作者：
Rybicki, L
中科院分区：
文献类型：
--
作者：
Bleasel, A;Kotagal, P;Rybicki, L
目的：部分性癫痫发作中的单侧肌张力障碍肢体姿势已被证明是准确的侧化标志，表明对侧半球癫痫发作。然而，其临床实用性可能会因与其他偏侧性发作运动现象混淆而降低。本研究对颞叶和颞外癫痫发作患者的肌张力障碍姿势、强直肢体姿势、单侧肢体不动和旋转等发作现象进行了区分和检查。方法：对 54 例经手术成功治疗的部分性癫痫患者（颞叶 34 例，颞外 20 例，额叶 14 例，顶叶 3 例，枕叶 3 例）进行盲法分析，由 3 名评价者进行盲法分析。使用 kappa 指数测试观察者间的一致性，并确定每个体征的阳性预测值 (PPV)。 结果：在颞叶癫痫 (TLE) 患者中，35.3% 发生肌张力障碍姿势（kappa 0.78，癫痫发作对侧体征的阳性预测值 (PPV) 为 92%）； 17.7% 的人出现强直肢体姿势（kappa 0.36，PPV 40%）；单侧肢体不活动的发生率为 11.8%（kappa 0.23，PPV 100%）；版本发生率为 35.3%（kappa 0.77，PPV 100%）。颞外癫痫患者中，20.0% 发生肌张力障碍姿势（kappa 0.31，PPV 100%）；强直肢体姿势发生率为 15.0%（kappa 0.08，PPV 67%）；版本发生率为 40.0%（kappa 0.54，PPV 100%）。 TLE 中较高的 kappa 指数对于肌张力障碍姿势 (p < 0.001) 和强直肢体姿势 (p = 0.032) 具有显着意义。肌张力障碍姿势 (p = 0.034)、强直姿势 (p = 0.07) 和版本 (p = 0.0038) 在颞外癫痫发作中比颞叶癫痫发作更早发生。结论：在肢体发作运动现象中，只有肌张力障碍姿势是准确的，并且观察者间一致性良好。
Purpose: Unilateral dystonic limb posturing in partial seizures has been shown to be an accurate lateralizing sign indicating seizure onset in the contralateral hemisphere. However, its clinical utility may be reduced by confusion with other lateralized ictal motor phenomena. In this study, the ictal phenomena of dystonic limb posturing, tonic limb posturing, unilateral immobile limb, and version were distinguished and examined in patients with temporal and extratemporal seizures.Methods: Partial seizures in 54 patients, successfully treated by surgery (34 temporal, 20 extratemporal; 14 frontal, 3 parietal, and 3 occipital), were analyzed blindly by 3 reviewers. Interobserver agreement was tested with kappa indexes and positive predictive value (PPV) was determined for each sign.Results: In patients with temporal lobe epilepsy (TLE), dystonic posturing occurred in 35.3% (kappa 0.78, positive predictive value (PPV) for the sign being contralateral to seizure onset 92%); tonic limb posturing occurred in 17.7% (kappa 0.36, PPV 40%); unilateral immobile limb occurred in 11.8% (kappa 0.23, PPV 100%); and version occurred in 35.3% (kappa 0.77, PPV 100%). In patients with extratemporal epilepsy, dystonic posturing occurred in 20.0% (kappa 0.31, PPV 100%); tonic limb posturing occurred in 15.0% (kappa 0.08, PPV 67%); and version occurred in 40.0% (kappa 0.54, PPV 100%). The higher kappa indexes were significant for dystonic posturing (p < 0.001) and tonic limb posturing (p = 0.032) in TLE. Dystonic posturing (p = 0.034), tonic posturing (p = 0.07), and version (p = 0.0038) occurred earlier in extratemporal seizures than in temporal seizures.Conclusions: Of the limb ictal motor phenomena, only dystonic posturing was accurate and had good interobserver agreement.