起源于额间沟的癫痫发作——对额叶癫痫症状学分组体系的补充  

Seizures originating from intermediate frontal sulcus:a supplement to symptomatic grouping system of frontal lobe epilepsy

作　　者：董晓立 李恺煇 郭强 费凌霞 胡湘蜀 李花 郭静 赵黎明 金洋 张佩琪 DONG Xiao-li;LI Kai-hui;GUO Qiang(Department of Epilepsy Center,Guangdong Sanjiu Brain Hospital Affiliated to Jinan University,Guangzhou 510510,China)

机构地区：[1]广东三九脑科医院癫痫中心,广州510510

出　　处：《临床神经外科杂志》2021年第3期310-315,321,共7页Journal of Clinical Neurosurgery

基　　金：广东省医学科学技术研究基金项目(B2019105);广东三九脑科医院院内课题(A39202008)。

摘　　要：目的研究起源于额间沟局灶性皮质发育不良(FCD)癫痫的临床症状学特点。方法回顾性分析5例起源于额间沟的癫痫患者的临床资料;分析患者的症状学、电生理学表现,随访观察手术疗效。结果3例患者的致痫灶为右侧额间沟,2例患者为左侧额间沟,均行手术治疗。其中3例患者行立体定向脑电图(SEEG)检查确认额间沟为致痫灶;1例患者行射频热凝毁损术,其余4例患者行病灶或致痫灶切除术。5例患者术后随访疗效均达EngelⅠa级,其中3例患者的症状学表现难以按Chauvel额叶癫痫症状学分组体系归类。结论起源于额间沟的癫痫,即起源于额极10区、9/46区的额叶癫痫,症状学可表现为恐惧、复杂运动,或同时伴有强直、肌张力障碍、强直-阵挛等基本运动症状,但亦可经额叶纵向系统(FLS)将放电直接传导至SMA区,症状学可仅表现为累及双侧面肌、颈肌、躯干肌、肢体近端肌的强直,并不出现复杂运动;此点可作为对Chauvel经典额叶癫痫症状学分组体系的补充。Objective To study the clinical symptomatic characteristics of epilepsy originated from focal cortical dysplasia(FCD)in the intermediate frontal sulus(Imfs).Methods The clinical data of 5 patients with epilepsy originating from the Imfs were analyzed retrospectively.The symptomatology and electrophysiology of the patients were analyzed,and the curative effect was observed.Results The epileptogenic foci of 3 patients were right Imfs and 2 patients were left Imfs,all of which were treated by operation.Three patients were examined by stereotactic EEG(SEEG)to confirm that the Imfs was the focus of epilepsy.One patient underwent radiofrequency thermal coagulation and the other 4 patients underwent focus or epileptogenic resection.The followup results of 5 patients were all Engel class A,among which,the symptom of 3 patients was difficult to classify according to the Chauvel frontal lobe epilepsy symptom group system.Conclusions Epilepsy originated from Imfs,that is,frontal lobe epilepsy originated from frontal pole area 10 and 9/46.Symptomatology can show fear,complex movement,or accompanied with basic motor symptoms such as ankylosis,dystonia,and tonic clonus.However,discharge can also be directly transmitted to SMA area through frontal longitudinal system(FLS)There is no complex movement in the rigidity of proximal limb muscles.This point can be used as a supplement to Chauvel’s classical symptomatic grouping system of frontal lobe epilepsy.

关 键 词：额叶癫痫 立体定向脑电图 额间沟 额极 

分 类 号：R742.1[医药卫生—神经病学与精神病学]