顶叶癫痫--从症状学分析到定位诊断  

Parietal lobe epilepsy-from semiology to localization

作　　者：张玮[1] 龙绮婷 龚德山 刘兴洲 ZHANG Wei;LONG Qiting;GONG Deshan(Epilepsy Center , Shanghai Deji Hospital, Shanghai (200331),China)

机构地区：[1]上海德济医院癫痫中心(青岛大学第九临床医学院),上海200331

出　　处：《癫痫与神经电生理学杂志》2019年第3期134-143,共10页Journal of Epileptology and Electroneurophysiology(China)

摘　　要：目的:通过对顶叶癫痫发作症状学、致痫区定位、相关皮质受累区的研究,揭示顶叶癫痫症状学和相关皮质网络的关系.方法:本研究入选2017年3月至2018年6月期间,通过立体定向脑电图(stereoelectroencephalography,SEEG)完成致痫区定位诊断,并进行外科手术及术后随访确诊的顶叶癫痫病例17例.对其发作期颅内电极脑电图、症状学进行分析,并对皮质受累区、症状学成分进行聚类分析、Kendall相关分析,获得二者的相关性.结果:皮质聚类分析将顶叶皮质分为3个组,第Ⅰ组又分为3个亚组.第Ⅰa组包括顶内沟前部、顶内沟后部、后扣带回背侧部、后扣带回腹侧部、楔前叶后部、顶枕沟;显著相关症状学成分包括强迫性眼球凝视、对称性面肌强直、过度运动、双侧非对称性强直姿势、复杂运动.第Ⅰb组包括顶上小叶,与中央前回、中央前沟聚为一类;显著相关症状学成分包括对侧上肢、下肢强直/强直阵挛、强迫性眼球凝视.第Ⅰc组包括楔前叶前部、扣带沟缘支,与中扣带回聚为一类;显著相关症状学为双侧非对称性强直、过度运动、强迫性眼球凝视,与对称性面肌强直存在一定的相关性.第Ⅱ组顶叶皮质为顶下小叶,包括角回、缘上回,与颞叶聚为一类;显著相关症状学包括自动运动、复杂运动,另外角回与强迫性眼球凝视、缘上回与对侧偏转发作具有一定的相关性.第Ⅲ组顶叶皮质为顶盖区,包括中央盖后部和缘上回盖部,与中央前回聚为一类;相关症状学包括对侧面肌强直/强直阵挛、眼睑阵挛/快速眨眼、躯干/双侧近端强直.从症状学角度看,对侧肢体强直/强直阵挛与顶上小叶、楔前叶前部相关性较大.对侧面肌强直阵挛、眼睑阵挛与中央盖、缘上回盖部相关.双侧非对称性强直、双侧面部对称性强直、过度运动均和后扣带回、楔前叶存在相关性.躯干/双侧近端强直与顶盖具有�Objective: To investigate the correlation between the semiological components and involved cortical areas through detailed analysis of parietal epileptic seizure semiology and the ictal SEEG. Method: From January 2014 to October 2015, 17 patients with parietal lobe epilepsy undertook SEEG examination to decide the epileptogenic zone and cortical resection to receive seizure-freedom confirmed by postsurgical follow-up. Semiology and ictal SEEG of the cases' 238 seizures were analyzed in detail. and cluster analysis followed by Kendall correlations of certain semiological components and cortical areas were used to manifest the localization value of semiological components. Result: According to the cortical cluster analysis, the cortical areas during the ictal period were catego rized into 3 groups. Group I was further classified as la. Ib and Ic. Group la included anterior and posterior intraparietal sulci? dorsal and ventral aspect of posterior cingulate cortex, posterior aspect of precuneus and parieto-occipital sulci.. Forced eye stare, symmetric facial tonic, hypermotor, bilateral asymmetric tonic posture and complexmotor had significant correlation with cortical Group la. Superi or parietal lobule was classified as Group Ib with precentral gyri and sulci. Contralateral tonic or tonicclonic seizure and forced eye stare were significantly correlated with Group Ib. Group Ic included anterior precuneus, marginal ramus of cingulate sulci, and significantly correlated with bilateral asymmetric tonic posture hypermotor and forced eye stare. Inferior parietal lobule including supramarginal gyri and angular gyri were classified with temporal lobe as Group Ⅱ and significantly correlated with automotor. complexmotor. Angular and supramarginal gyri were also correlated with forced eye stare and versive seizure respectively. Parietal opercular areas, including central and supramargincal operculum were categorized as GroupⅢ and correlated with contralateral facial tonic or tonic-clonic, eyelids clonic seizure, and trunk

关 键 词：顶叶癫痫 症状学 皮质网络 

分 类 号：R742.1[医药卫生—神经病学与精神病学]