起源于颞叶的过度运动发作的电－临床特征分析  

The electroclinical characteristics of hypermotor seizures originating from the temporal lobe

作　　者：遇涛[1] 张国君[1] 倪端宇[1] 乔梁[1] 徐翠萍[1] 周晓霞[1] 王玉平[2] 李勇杰[1] 

机构地区：[1]首都医科大学宣武医院,北京功能神经外科研究所,100053 [2]首都医科大学宣武医院神经内科,100053

出　　处：《中华神经科杂志》2016年第5期353-357,共5页Chinese Journal of Neurology

基　　金：2014年度首都卫生发展科研专项项目（首发2014-4-2014）

摘　　要：目的描述一组颞叶起源的过度运动发作患者的电一临床特征。方法回顾分析2001年4月至2015年2月在北京功能神经外科研究所经手术证实起源于颞叶的过度运动发作12例患者临床资料，包括发作病史、影像学改变、视频脑电图监测数据、手术及病理结果。结果10例有先兆症状。发作期症状表现为剧烈动作的有7例，轻度动作的有5例。12例患者在出现过度运动症状的同时，对侧上肢或肢体有一定程度的僵硬或肌张力障碍样动作。8例进行了颅内电极长程记录，共记录到29次发作，从颞叶导联起始期电活动出现到过度运动症状出现，整个过程历经（22．8±8．4）s，其中颞叶导联首先记录到起始期电活动与额叶导联记录到发作期电活动之间的时间间隔为（16．0±8．2）s，从额叶导联记录到发作期电活动到过度运动症状出现之间的时间间隔为（6．3±6．1）s，两者差异有统计学意义（t=4．442，P=0．000）。12例患者均行前颞叶切除手术，术后随访6～72个月，10例发作消失，其余2例术后不再表现为过度运动性发作。结论一些过度运动发作可以起源于颞叶，其过度运动症状常在发作期电活动累及额叶时出现。手术切除致痫灶可获得满意疗效。Objective To describe the characteristics of electroclinical manifestations in patients with hypermotor seizures （HMSs） originating from the temporal lobe. Methods The data of 12 patients who had HMSs of temporal origin and underwent surgical treatment from April 2001 to February 2015 in Beijing Institute of Functional Neurosurgery were retrospectively reviewed, including seizure histories, imaging reports, video-electroencephalogram （EEG） monitoring, operative records and pathological findings. Results Ten of the 12 patients were reported auras. The ictal behavior included marked agitation in 7 patients and mild agitation in 5 patients. All of the 12 patients with HMSs concomitantly appeared contralateral stiffness or dystonia of the upper limb or both limbs to a certain extent. Eight of the 12 patients underwent intracranial recording, in which 29 seizures were recorded in total. The time interval from temporal EEG origination to the beginning of hypermotor behavior was （ 22. 8 ± 8.4 ） s. The time interval of ictal propagation from the temporal to frontal lobe was （16. 0 ± 8. 2 ） s, and that from the frontal lobe involving to the beginning of hypermotor behavior was （ 6. 3±6. 1 ） s, with statistically significant difference （ t = 4. 442, P = 0. 000）. All of the 12 patients were followed for 6 to 72 months after the anterior temporal lobeetomy, in which 10 cases remained seizure-free, and 2 were only relieved from HMSs. Conclusions Some HMSs can originate from the temporal lobe and the hypermotor behaviors maybe occur when the ictal neural network involves the frontal lobe. Therefore, surgical resection may lead to satisfied outcomes.

关 键 词：过度运动发作 癫痫 颞叶 脑电描记术 神经外科手术 

分 类 号：R742.1[医药卫生—神经病学与精神病学]