Symptomatology of epileptic seizures in the first three years of life
Symptomatology of epileptic seizures in the first three years of life
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DOI：
10.1111/j.1528-1157.1999.tb00789.x
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发表时间：
1999-07-01
期刊：
影响因子：
5.6
通讯作者：
Acharya, J
中科院分区：
文献类型：
--
作者：
Hamer, HM;Wyllie, E;Acharya, J
目的：关于婴儿癫痫发作的症状学资料很少。方法：回顾我院1988 ~ 1998年进行视频脑电图监测的76例1 ~ 35个月（平均15.1个月）患者的296次癫痫发作录像。癫痫症状首先根据观察到的行为和运动表现进行分类，然后与发作期脑电图相关联。结果：四种癫痫类型占本组所有癫痫发作的81%：癫痫性痉挛（24%）、慢性癫痫发作（20%）、强直性癫痫发作（17%）和低运动性癫痫发作（20%；特征为行为运动活动停止或显著减少，意识水平不确定）。其余的发作包括少量的肌阵挛性、张力性和反转性发作。所有12次局灶性运动发作和所有5次反转性发作均与局灶性脑电图发作模式相关，除1例反转性发作患者外，其余患者均出现对侧半球。全身性运动发作（临床全身性发作）伴有局灶性脑电图发作（51例中19例，37%）或全身性脑电图发作（51例中32例，63%）。低运动性发作还与局灶性（14 / 20,70%）或全局性（6 / 20,30%）脑电图发作相关。4例全身性癫痫痉挛患者在局灶性癫痫背景下出现全身性脑电图发作，基于神经影像学，间歇期脑电图，2例也在术后癫痫发作自由。在这个年龄组中未见的癫痫类型包括先兆性发作、明显的自动性发作（除一例外）和典型的全身性强直-阵挛性发作。结论：前3年癫痫发作的表现是有限的。在婴儿中，局灶性运动性发作与对侧半球的局灶性脑电图发作可靠相关，而全身性运动性和低运动性临床发作可能是局灶性或全身性脑电图发作。癫痫痉挛可见于局灶性癫痫和全身性癫痫。视频脑电图监测和神经成像可能是关键澄清局灶性或全身性癫痫在婴儿。
Purpose: Few data are available concerning symptomatology of epileptic seizures in infants.Methods: We reviewed 296 videotaped seizures from 76 patients aged 1-35 months (mean, 15.1 months) who underwent video-EEG monitoring at our institution from 1988 to 1998. Seizure symptomatology was first classified based on observable behavioral and motor manifestations and then correlated with ictal EEG.Results: Four seizure types accounted for 81% of all seizures seen in this group: epileptic spasms (24%), clonic seizures (20%), tonic seizures (17%), and hypomotor seizures (20%; characterized by arrest or significant decrease of behavioral motor activity with indeterminate level of consciousness). The remaining seizures included small numbers of myoclonic, atonic, and versive seizures. All 12 focal motor seizures and all five versive seizures were associated with focal EEG seizure patterns, seen in the contralateral hemisphere in all but one patient with versive seizures. Generalized motor seizures (clinically generalized at onset) were accompanied either by focal (19 of 51; 37%) or generalized (32 of 51; 63%) EEG seizures. Hypomotor seizures also were associated with focal (14 of 20; 70%) or generalized (six of 20; 30%) EEG seizures. Four patients with generalized epileptic spasms had generalized EEG seizures in the setting of focal epilepsy based on neuroimaging, interictal EEG, and in two cases also on postresection seizure freedom. Seizure types not seen in this age group included auras, seizures with prominent automatisms (except in one case), and classic generalized tonic-clonic seizures.Conclusions: The repertoire of seizure manifestation in the first 3 years of life appears to be limited. In infants, focal motor seizures are reliably associated with focal EEG seizures in the contralateral hemisphere, whereas generalized motor and hypomotor clinical seizures may be either focal or generalized on EEG. Epileptic spasms may be seen in focal as well as generalized epilepsies. Video-EEG monitoring and neuroimaging may be critical for clarifying the focal or generalized nature of the epilepsy in infants.