摘要
目的总结额盖癫痫的临床、电生理及影像学特征。方法回顾性分析2020年12月至2022年12月年深圳市第二人民医院功能神经科收治的5例额盖起源的局灶性癫痫患者的临床资料,其中4例行立体定向EEG(SEEG)引导下射频热凝术,总结患者的临床表现、电生理特征及头颅影像学表现。结果5例患者发病年龄2~17岁,病程1~20年,均每天发作,夜间多发,发作持续不足30 s,意识恢复迅速。3例表现为过度运动Ⅰ或Ⅱ型,均有以躯干为轴左右翻转的成分,其中2例有发笑,1例有恐惧表情;另外2例表现为对称性强直,均累及面部。1例有难以描述的先兆。2例有自主神经症状。5例患者EEG间歇期放电均以额区为著,仅2例有定侧价值,4例发作期以全导低波幅快节律(LVFA)起始,1例以病灶侧低频节律性尖慢复合波起始。4例进行了SEEG,发作期均以额盖及其邻近电极为著LVFA起始,均迅速传导至岛及岛盖、额叶内侧面等脑区。4例头颅MRI有阳性改变,2例为皮质发育不良可能,1例为结节性硬化,1例为软化灶改变。4例患者均进行了SEEG引导下射频热凝术,发作均减少。结论额盖癫痫主要表现为伴躯干为轴左右翻转成分的过度运动或对称性强直发作,可伴情感症状或面肌强直,先兆及自主神经症状少见。EEG定侧价值有限,SEEG提示岛及岛盖、额叶内侧面早期受累。
Objective To summarize the clinical,electrophysiological and imaging features of frontal opercular epilepsy.Methods A retrospective analysis was conducted on 5 cases with frontal opercular epilepsy,who were treated at the Department of Functional Neurology,Shenzhen Second People's Hospital from December 2020 to December 2022.Among these cases,4 cases were underwent stereotactic-EEG(SEEG)guided radiofrequency thermocoagulation.The clinical,electrophysiological,and imaging characteristics of these 5 cases were summarized.Results The 5 cases had an onset age ranging from 2 to 17 years and a disease duration ranging from 1 to 20 years.All of them experienced daily seizures,especially at night.The seizure duration was less than 30 seconds,and consciousness recovered rapidly.Among the cases,3 exhibited hypermotor seizures of type Ⅰ or Ⅱ,characterized by body turning along the horizontal body axis.Two of them experienced laughter during the seizures,while 1 showed a fearful expression.The remaining 2 cases presented with symmetric tonic seizures,involving the facial muscles.One case reported indescribable aura,and 2 cases had autonomic symptoms.During the interictal period,all 5 cases showed epileptic discharges predominantly in the frontal region on EEG,with lateralization value present in only 2 cases.During the ictal period,4 cases demonstrated general low volatility and fast activity(LVFA),while 1 case showed low-frequency rhythmic sharp and slow waves originating from the lesioned side.Four cases underwent SEEG,which revealed seizure starting from the frontal operculum and adjacent electrodes with LVFA,rapidly spreading to the insula,insular opercular,and medial frontal lobe.Positive changes were observed in the MRI of 4 cases,including 2 cases with possible cortical dysplasia,1 case with tuberous sclerosis,and 1 case with encephalomalacia foci.All 4 cases underwent SEEG guided radiofrequency thermocoagulation,resulting in seizure frequency reduction.Conclusions Frontal opercular epilepsy is mainly characterized by hypermotor seizure with body turning along the horizontal body axis or symmetric tonic seizure.These seizure may be accompanied by emotional symptom or facial muscle tonic,but aura and autonomic symptom are less common.The lateralization value of EEG is limited in frontal opercular epilepsy.SEEG indicates early involvement of the insula,insular opercular,and medial frontal lobe.
作者
黎思娴
姚晨
王圆庆
陈俊喜
肖小华
王波
杨花峰
蔡晓东
LI Sixian;YAO Chen;WANG Yuanqing(Department of Functional Neurosurgery,Shenzhen Second People's Hospital,the First Affiliated Hospital of Shenzhen University,Shenzhen 518035,China)
出处
《临床神经病学杂志》
CAS
2023年第6期430-434,共5页
Journal of Clinical Neurology
关键词
额盖癫痫
躯干翻转
发笑
面部强直
立体定向EEG
frontal opercular epilepsy
body turning along the horizontal body axis
laughter
facial muscle tonic
stereotactic-EEG
