Recurrent secondary generalization in frontal lobe epilepsy: Predictors and a potential link to surgical outcome?
Recurrent secondary generalization in frontal lobe epilepsy: Predictors and a potential link to surgical outcome?
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DOI：
10.1111/epi.13086
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发表时间：
2015-09-01
期刊：
影响因子：
5.6
通讯作者：
Seeck, Margitta
中科院分区：
文献类型：
--
作者：
Baud, Maxime O.;Vulliemoz, Serge;Seeck, Margitta
额叶癫痫（FLE）常导致继发性全身强直阵挛发作（SGTCS）。然而，鲜为人知的是SGTCS的临床，电生理和放射学相关性，以及这些是否会影响诊断和treatment.MethodsA队列48例确诊FLE回顾性确定和二分成一组和一组没有SGTCS定义的历史（1/年）或视频脑电图（vEEG）。将人口统计学、癫痫发作症状学、vEEG、神经影像学数据和估计的癫痫发作区制表，并使用卡方检验评价其与SGTCS发生的相关性。SGTCS的独立预测因素采用逐步多变量分析进行确认。同样，这些预测因素以及SGTCS病史作为手术亚组（n=25）术后国际抗癫痫联盟（ILAE）评分的多变量预测因素进行了测试。结果我们确定了FLE中SGTCS病史的三个独立预测因素，包括癫痫发作时反应性丧失（校正p=0.04），涉及早期基本运动体征的符号学（校正p=0.01）和EEG上的多灶性棘波（校正p=0.02）。57%的手术病例发生了无并发症结局，并且在未使用SGTCS的组中更有可能发生（100%，p=0.001）。当考虑只有SGTCS发生在视频脑电图监测，与症状学和手术结果消失，但与保存意识和多灶性EEGstress.SignificanceA的SGTCS的历史相关的一个特定的发作症状学和发作间期脑电图，并可能在手术风险分层的作用。
ObjectiveFrontal lobe epilepsy (FLE) frequently leads to secondary generalized tonic-clonic seizures (SGTCS). However, little is known about the clinical, electrophysiologic, and radiologic correlates of SGTCS and whether these could influence diagnosis and treatment.MethodsA cohort of 48 patients with confirmed FLE was retrospectively identified and dichotomized into a group with and a group without SGTCS defined by history (1/year) or video-electroencephalography (vEEG). Demographics, seizure semiology, vEEG, neuroimaging data, and estimated seizure-onset zone were tabulated, and their association with the occurrence of SGTCS was evaluated with use of a chi-square test. Independent predictors of SGTCS were confirmed using a stepwise multivariate analysis. Similarly, these predictors as well as a history of SGTCS were tested as multivariate predictors of the postoperative International League Against Epilepsy (ILAE) score in the surgical subgroup (n=25).ResultsWe identified three independent predictors of a history of SGTCS in FLE, including loss of responsiveness at seizure onset (corrected p=0.04), a semiology involving early elementary motor signs (corrected p=0.01), and multifocal spikes on EEG (corrected p=0.02). A seizure-free outcome occurred in 57% of surgical cases and was more likely in the group without SGTCS (100%, p=0.001). When considering only SGTCS occurring during video-EEG monitoring, the association with semiology and surgical outcome vanished, but the association with preserved awareness and a multifocal EEG persisted.SignificanceA history of SGTCS is related to a specific ictal semiology and interictal EEG, and may have a role in surgical risk stratification.