Nocturnal hypermotor seizures, suggesting frontal lobe epilepsy, can originate in the insula
Nocturnal hypermotor seizures, suggesting frontal lobe epilepsy, can originate in the insula
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DOI：
10.1111/j.1528-1167.2006.00510.x
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发表时间：
2006-04-01
期刊：
影响因子：
5.6
通讯作者：
Kahane, P
中科院分区：
文献类型：
--
作者：
Ryvlin, P;Minotti, L;Kahane, P
目的：报告3例耐药性夜间过度运动发作（NHSs）患者，无脑部可检测病变，临床诊断为夜间额叶癫痫（NFLE）或常染色体显性遗传夜间额叶癫痫（ADNFLE），其脑内脑电图发作起始主要累及脑岛，而非内侧或眶额皮质。
方法：每位患者植入14 - 15个脑内电极，主要对额叶进行采样，80 - 91条记录导联覆盖最可能的发作起始侧，2 - 6条导联置于同侧脑岛。用电刺激来测试各个记录部位额叶和脑岛区域的癫痫阈值。
结果：在所有3例患者中，发作起始时在脑岛的前上部分记录到低电压快活动，要么单独出现，要么在ADNFLE患者中延伸至附近的额盖。在所有3例患者中，脑岛的作用得到进一步支持，要么是该区域明显占优势的高幅棘波（n = 2），要么是在该部位选择性施加电刺激时触发患者典型的先兆或发作（n = 2）。
结论：脑岛的前上部分可能在一些无病变的耐药性癫痫提示为NFLE或ADNFLE的患者中产生夜间过度运动发作起关键作用。这些患者是否适合成功手术仍是一个未解决的问题。
Purpose: To report three patients with drug-resistant nocturnal hypermotor seizures (NHSs), no detectable brain lesion, and clinically defined nocturnal frontal lobe epilepsy (NFLE) or autosomal dominant NLFE (ADNFLE), whose intracerebral EEG ictal onset primarily involved the insula, rather than the mesial or orbital frontal cortex.Methods: Fourteen to 15 intracerebral electrodes were implanted in each patient, primarily sampling the frontal lobes with 80 to 91 recording leads covering the most likely side of seizure onset, and two to six leads placed within the ipsilateral insula. Electrical stimulation was used to test the epileptic threshold of frontal and insular brain regions at the various recording sites.Results: In all three patients, a low-voltage fast activity was recorded within the anterosuperior aspect of the insula at ictal onset, either in isolation, or extending to the nearby frontal operculum in the ADNFLE patient. The role of the insula was further supported in all three patients either by the presence of high-amplitude spikes that clearly predominated over that region (n = 2) or by triggering the patient's typical aura or seizure when applying an electrical stimulation at that site, selectively (n = 2).Conclusions: The anterosuperior portion of the insula might play a pivotal role in generating nocturnal hypermotor seizures in some patients with nonlesional drug-resistant epilepsy suggesting NFLE or ADNFLE. Whether these patients are amenable to successful surgery remain an open issue.