摘要
[目的]
分析颞叶癫痫患者的临床表现、脑电图及影像学特点。
[方法]
对28例住院行视频脑电图(Video-EEG)检查的颞叶癫痫患者的病史、临床表现、脑电图(EEG)及神经影像学,进行回顾性分析。
[结果]
28例颞叶癫痫患者中,13例(46.43%)患者的首次发病年龄≤15岁；17例(60.71%)患者能找到病因,主要包括脑外伤、颅内占位、脑血管病、海马硬化和颅内感染等；7例(25.00%)患者临床发作前有先兆,表现为似曾相识感,恐惧感,胃气上冲感,头晕乏力及心慌；15例(53.57%)患者有复杂部分性发作(CPS),10例(35.71%)患者发作时表现为自动症,出现反复咂嘴、吞咽、空口咀嚼,及手部摸索、抓握等；Video-EEG检查在发作间期痫样放电检出率为82.14%,发作期痫性放电检出率为91.67%；磁共振(MRI)阳性率为46.15%,影像学异常主要包括海马萎缩,海马区占位,海马异常信号,颞叶软化灶,颞枕叶占位及颞顶叶缺血梗塞灶等。
[结论]
颞叶癫痫首发年龄以儿童期及青少年期为高,先兆症状以似曾相识感、恐惧感及胃气上冲感为主,发作类型以CPS多见,自动症以口咽部及手部自动症为主,Video-EEG痫样放电检出率高,结合临床发作表现、Video-EEG及MRI等综合分析有助于致痫灶的准确定位。
[Objective]
To discuss the clinical, electroencephalogram and imaging characteristics of temporal epilepsy.
[Methods]
28cases of the patients who had received Video-EEG checking in the hospital were analyzed of history, clinical manifestation, EEG and neuro-imaging.
[Results]
Among28patients,13cases (46.43%) of the patients onset under15years.17cases (60.71%) of the patients can find the causes, mainly including head injury, intracranial space occupying lesion, cerebrovascular diseases, hippocampal sclerosis and intracranial infection, etc.7cases (25.00%) of the patients have presymptom before the seizure, including the sense of dejavu, fear, sense of stomach gas rushed, dizziness, flustered, etc.15cases (53.57%) of the patients show complex partial seizures (CPS),10cases (35.71%) of the patients show automatism, such as repeated smacking, swallowing, chewing with nothing, feeling and griping with hands, etc. The detection rate of epileptiform discharges in the interictal period on Video-EEG is82.14%, and in the episode period is91.67%. The positive rate of MRI is46.15%, the imaging abnormalities mainly involve the hippocampal atrophy, hippocampus occupying lesions, abnormal signal in the hippocampus, soften focus in temporal lobe, temporo-occipital occupying lesions and temporoparietal ischemia infarct, etc.
[Conclusion]
The first-episode age of temporal epilepsy in childhood and adolescence is high. The main premonitory symptoms are a sense of dejavu, fear, and a sense of stomach gas rushed. The common attack type is CPS, oropharynx and hands automatism are the most common automatism. The detection rate of epileptiform discharges on Video-EEG is high, comprehensive analysis with clinical manifestation, Video-EEG and MRI can help accurately positioning epileptic foci.
引文
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