复杂部分性癫痫状态1例报告

1病例 男,42岁。入院前10月患者无明显诱因突发头昏、呕吐、大汗,赴当地医院诊治(具体不详),1一2天后好转,以后类似症状每隔1一2月发作l次,均在院外诊治l一2天后好转。人院前2月     

18例复杂部分性癫痫发作同步录像脑电图监测报告

目的：搪塞同步录像离电图在复杂部分性癫痫发作诊断中的应用价值。方法：利用ＺＮ８０００型ＥＥＧ仪对临床确诊的１８例复杂部分性发作患者进行脑电和行为监测,监测时间２．５￣２８ｈ,平均１８,８ｈ,结果：共监测到９３次临床发作,睡眠中发作５４次,清醒时发作３９ ,发作持续时间７－１２０ｓ,平均３４．８ｓ。发作时的临床表现：双眼向前或向一侧凝视１１例,头向一侧转动９例,一侧面部或肢体抽９例,行为或口咽自动症     

癫痫复杂部分性发作2例报道

1 病例 例1女,6岁,因发作性睡眠3年于2001年10月20日就诊,3年来患儿白天多睡,其特点是在走路、吃饭、玩耍和听课等各种活动中突然发生,不能克制,每次持续约2～3小时,发作时不伴有肢体抽搐和肌肉纤颤,用强刺激可以唤醒,但仍呈意识模糊状态,常有尿失禁,醒后不能回忆,病初期数日或数月发生1次,近半年来,发作为数日1次或1日数次,夜间睡眠正常,无脑炎及颅脑外伤史,也无癫痫和发作性睡眠家族史。查体:神志清楚,精神好,无神经系统受损体征,心、肺、腹检查均正常,脑电图示额叶出现少量双侧同步而对称的100～200μV尖波,诊断为发作性睡眠。给予鲁米那每次20 mg,每日3次口服治疗,半月后发作停止,鲁米那减量维持,随访半年未复发,复查脑电图恢     

中老年复杂部分性发作癫痫持续状态的临床特征及误诊分析

目的 分析中老年复杂部分性发作癫痫持续状态(CPSE)的临床特点及误诊原因.方法 收集广州医学院第二附属医院神经内科自2008年1月至12月收治、曾被外院误诊的中老年CPSE患者的临床资料,进行视频脑电图(EEG)、头颅MR、生化检查,根据国际抗癫痫联盟的CPSE诊断标准进行诊断,并随访3个月以上. 结果 本组患者7例,均为女性,其中额叶癫痫(FLE)2例,颞叶癫痫(TLE)5例;CPSE患者临床症状和视频EEG表现多样化;经抗癫痫药物(AEDs)治疗后3例至少3个月无发作,3例仍有CPSE发作,1例仍有反复CPSE. 结论 由于CPSE患者临床症状和EEG表现欠典型,常合并其他系统疾病和社会因素的影响易被误诊,应及早做视频EEG检查以明确诊断;口服AEDs治疗可取得良好效果.     

复杂部分性癫痫持续状态

本文对CPSE的临床症状、分型、脑电图改变、诊断及鉴别诊断,治疗及预后作了全面介绍.CPSE为一种电临床综合征,临床表现为精神异常,可持续存在或交替出现.脑电图有局灶性放电或由局灶泛化为普遍性放电,要注意与其他精神异常及AS鉴别.     

表现为复杂部分性癫痫持续状态的脑囊虫病（附2例报告）

表现为复杂部分性癫痫持续状态的脑囊虫病（附２例报告）龚淑英，张广佩，卜晖，李莉，张和振，李凤岭例一、女，５３岁。４个月来发作性意识模糊，两眼发呆不认识家里人。不理解他人的语言对常用物品叫不上名字，也不知道怎么用，穿衣时不知道伸袖，常把上衣当裤子，下地...     

家族性间脑癫痫(附2个家系14例结合文献复习)

<正> 1925年Heko首次报道间脑癫痫以来,国内外陆续在世界各地被发现。家族性发病的间脑癫痫十分罕见。国内刘焯霖首先报道一个家族11例患者,我院神经科和儿科门诊分别发现一家族,现报告如下。     

发作性阴部疼痛型癫痫1例报告

患者 ,女 ,4岁。半年前突然阵发性、反复性哭闹诉阴部疼痛 ,不能制止地用手抓阴部。家人检查阴部无红肿 ,但患儿每次发作时表情异常痛苦 ,甚至恐惧、惊叫 ,持续 5～ 10分钟症状消失。发作后患儿呈倦怠状或入睡 ,醒后似无任何症状发生一样。发作前无任何不适 ,有时在进食中或与小朋友玩耍时突然发作 ,表现为哭闹不止 ,诉排小便处疼痛。在多家医院曾诊为尿路感染或皮肤病 ,用抗生素及氢化可的松软膏外搽无效。病初 2～ 3月发作一次 ,近 3月来渐增 ,1月甚至几天发作一次。无癫痫病家族遗传史 ,无脑外伤及寄生虫史。患儿属第二胎 ,足月顺产 ,婴…     

复杂部分性发作癫痫的认知功能与核磁共振的研究

目的探讨复杂部分性发作（CPS）癫痫患者的认知功能和头颅核磁共振检查的临床意义。方法对40例临床确诊的CPS患者进行认知功能和MRI检查和分析。结果（1）CPS癫痫患者认知功能障碍（52.5%）显著〉对照组（20.8%）,P〈0.05;（2）CPS患者组中MRI异常占57.5%,MRI和对照组比较有显著性差异（P〈0.01）;（3）认知功能和MRI异常呈负相关（r=-0.018～-0.286,P〉0.05）。结论认知功能、MRI检查对CPS的诊断和治疗有重要意义。     

额叶癫痫发作临床表现及脑电改变特征的分析

目的 探讨额叶癫痫发作临床表现及脑电改变特征。方法 利用ＺＮ８０００型同步录像脑电图（ＥＥＧ）对１０例额叶癫痫患者进行脑电和行为监测。结果 监测时间内共监测到８９次临床发作,睡眠６２次,清醒２７次,持续时间１０～９０秒。临床表现：单纯部分性发作３例１２次,复杂部分性发作６例７０次,强直－阵挛性发作１例７次;发作期ＥＥＧ：额区或额区为主的癫痫样放电（棘波、尖波、棘慢、尖慢综合波）８例７１次,高极高幅     

Febrile seizures in patients with complex partial seizures

Febrile seizures occurred in 14 of 155 (9%) out-patients with complex partial seizures. Twelve patients had prolonged or recurrent febrile seizures, convulsive status epilepticus or a transient postictal neurological deficit. Febrile seizures were associated with perinatal abnormalities, an earlier onset of epilepsy and with a poor seizure control. Recurrent febrile seizures or those with complicating features are associated with an unfavourable therapeutic outcome in adult patients with complex partial seizures.     

Opercular reflex seizures: a case report with stereo-electroencephalographic demonstration.

Reflex epileptic seizures of opercular origin have been described previously based on video-electroencephalographic monitoring, but very few patients have been explored with depth electrodes. We report a woman with late-onset epilepsy who had intractable seizures despite trials of several antiepileptic drugs. At the time of the depth-electrode recordings, seizures were usually continuous and occurred either spontaneously or were induced by movements of the jaw and mouth. The seizures originated in the deep central opercular cortex; localization was confirmed by a good surgical outcome.     

On the genetics of complex partial seizures: waking and sleep EEGs in siblings

Waking and sleep EEGs were recorded in 29 siblings of 19 patients with complex partial seizures. At least 1 sibling with epileptic activity (EA) was found for 36.8% of the patients. Taking the 29 siblings as a basis, in 7 EA was recorded. Most EA was seen during sleep in stage C (29%). More EA was recorded in female siblings (28% :18%) and in siblings of female patients (56% :20%). All EA was seen in the age range 5–14 years. Siblings with occipital theta-delta activity with a generalization tendency showed more EA (59%) than those without this pattern (8%). Of the siblings of patients with generalized EA 50% showed EA, but only 25% of those of patients with localized EEG patterns.     

Pilomotor seizures: a video case report

Piloerection is a rare ictal manifestation usually associated with temporal lobe epilepsy. We present video and electrographic documentation of pilomotor seizures in a 75-year-old man with left temporal lobe epilepsy and remote herpes zoster encephalitis. In general, piloerection is most often localised to the temporal lobe. Unilateral piloerection is usually associated with an ipsilateral ictal onset. Bilateral piloerection has a less certain lateralising value, although earlier reports suggest left hemispheric predominance [Published with videosequences].     

Pilomotor seizures: symptomatic vs. idiopathic report of two cases and literature review.

We report pilomotor seizures in two patients who presented with piloerection or gooseflesh spreading in a pattern similar to the 'Jacksonian march'. Gooseflesh was confined to the ipsilateral side in most of the episodes. Occasionally it spread to the contralateral side. It was also associated with other autonomic symptoms and complex partial features of temporal lobe origin. Simple partial status that progressed to complex partial status occurred in the second patient. Very rarely secondary generalization occurred. The cause was left sphenoid meningioma and temporal tip contusion in the first case. It was idiopathic in the second case, although a positive family history of complex partial seizures was obtained in this patient.Interictal electroencephalogram (EEG) showed left temporal focus in the first and bitemporal foci with right fronto-temporal dominance in the second. Parenteral phenytoin controlled the partial complex status in the second and carbamazepine controlled the episodes in both cases. To our knowledge all reported cases were symptomatic and our case of idiopathic aetiology is the first to be recorded. We endorse that pilomotor seizures are autonomic in nature and constitute a subtype of simple partial seizures. These autonomic simple partial seizures may progress to, or be a component of, complex partial seizures of temporal lobe origin. Based on their dominance in such a symptom complex and careful interpretation of the ictal history, it can be logically concluded that pilomotor seizures may be underestimated by both patients and physicians.     

Epileptic spasms and partial seizures as a single ictal event

PURPOSE: To investigate the phenomenon of epileptic spasms (ESs) associated with other seizure types in a single ictal event and to study the predictive value of this phenomenon regarding etiology and prognosis. METHODS: We selected retrospectively eight female and five male patients, who had ESs and other seizure types within a single seizure event and for whom a video-EEG recording of the phenomenon was performed in at least one situation. RESULTS: The seizure type associated with ESs was a partial seizure in all patients. We identified three groups with different seizure patterns regarding the temporal association of ES and partial seizures (PSs): (a) PS followed by ES; (b) PS appearing during a cluster of ESs without interrupting the cluster; and (c) complex seizure interaction with a succession of ESs and PSs in a close but variable temporal association. Underlying disorders included cortical dysplasia (three patients), complex cerebral malformations (two patients), and perinatal anoxic-ischemic injuries (two patients); four cases were classified as cryptogenic, and in two children, etiology was unknown, but prenatal origin was suspected. Outcome was poor in nine cases with intractable epilepsy; four cases had a favorable outcome, defined as complete cessation of epileptic seizures. CONCLUSIONS: The phenomenon of associated ESs and PSs as a single ictal event can be related to different etiologies and should not be considered distinctive for cortical malformations or severe brain damage. Different seizure patterns of associated ESs and PSs provide no hint for etiology or prognosis. Outcome is prevalently but not constantly unfavorable in patients with the phenomenon.     

Neuropsychological study during video-EEG recording of successive partial seizures of right temporo-central origin

A 15-year-old, right-handed boy underwent video-EEG study as a first step in presurgical evaluation for a severe drug-resistant right temporo-central epilepsy. He was monitored while performing neuropsychological tests over a 67-minute period during which 23 brief seizures were recorded. Despite his right-handedness, both inter-ictal and ictal verbal performances were impaired. Analysis of the relationships between the characteristics of the EEG and the neuropsychological results revealed that a worsening in cognitive performances correlated with an increase in interictal abnormalities, particularly when subclinical paroxysms were present; that the cognitive tasks executed peri-ictally were correctly performed in almost 50% of the cases; and that the error rate was higher when a task was presented during or immediately after a seizure rather than before its onset. A Wada test, performed on the basis of the cognitive results, demonstrated right hemisphere dominance for language. Our observations underline the importance of neuropsychological testing in presurgical procedures, and suggest that it should be performed peri-ictally whenever possible.

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Sommario Viene riportato il caso di un destrimane di 15 anni affetto da una grave epilessia farmaco-resistente centro-temporale destra e sottoposto a video-EEG come primo passo della valutazione prechirurgica. Durante il monitoraggio furono registrate 23 brevi crisi nell'arco di 67 minuti mentre eseguiva parte dell'indagine neuropsicologica. In intercritico e soprattutto in critico la prestazione del soggetto alle prove verbali è risultata deficitaria. Analizzando la relazione tra dati EEG e neuropsicologici abbiamo rilevato: — un peggioramento della prestazione cognitiva correlato ad un aumento delle anomalie intercritiche in particolare in presenza dei parossismi infraclinici; — che quando gli item erano eseguiti in percritico erano corretti circa il 50% delle volte; — un'alta incidenza di errori quando il compito era presentato durante o immediatamente dopo una crisi piuttosto che prima del suo inizio. Sulla base dei dati neuropsicologici è stato eseguito il test di Wada che ha dimostrato una dominanza emisferica destra per il linguaggio. Dalla nostra osservazione emergono l'importanza della valutazione neuropsicologica nell'approccio prechirurgico dell'epilessia e il suggerimento di utilizzarla in percritico quando possibile.

     

Post-ictal fever: a rare symptom of partial seizures

Although fever may induce seizures, especially in children, its occurrence following epileptic spells has been rarely described, except from generalized convulsive status epilepticus. We present two patients suffering from focal seizures accompanied by episodes of post-ictal fever, and review similar reports in the literature of the last 40 years. Temperature changes following non-convulsive seizures might be induced by gene upregulation occurring in the hypothalamus, the nucleus tractus solitarius, or in other brain regions, producing a local inflammatory response. Direct propagation of electrical discharges seems less consistent with the timing of development of this symptom. Heterogeneity of reported clinical features argues against the assumption of a definite localizing or lateralizing value for post-ictal fever.     

Posttraumatic Pilomotor Seizures: A Case Report

Pilomotor epilepsy is a rare phenomenon. A 35-year-old man suffered a traumatic contusion of the right temporal lobe and subsequently developed spells characterized by diffuse piloerection and sweating. We believe this to be the first reported association between pilomotor epilepsy and posttraumatic head injury. Although pilomotor seizures may result from diverse etiologies, they appear to have a common involvement of temporolimbic structures.     

Pilomotor seizures in frontal lobe epilepsy: case report.

We report a 27-year-old man with pilomotor seizures originating in the right frontal lobe. Subtracted ictal SPECT coregistered with MRI showed multifocal hyperperfused areas in the anterior medial frontal area, mainly involving the cingulate gyrus. Chronic electrocorticography with subdural electrode arrays during the piloerection demonstrated that the pilomotor seizures were originating in the anterior medial frontal region. After resection of the focus, the patient became seizure free.