仅有意识障碍的癫痫复杂部分性发作八例误诊分析

目的 分析仅有意识障碍的癫痫复杂部分性发作的临床特点及误诊原因.方法 对我院2010年1月-2012年12月收治并误诊的癫痫复杂部分性发作8例的临床资料进行回顾性分析.结果 8例均表现为突然动作停止,两眼发直,呼之不应,但无跌倒、面色改变,也无不自主、无意识动作发生,且发作后可继续原来活动,每次发作持续数秒至数分钟,发作后有短暂定向力障碍.误诊为椎-基底动脉系统短暂性脑缺血发作（TIA）、晕厥各3例,癫痫典型失神发作2例.根据发作间歇期24h动态脑电图（AEEG）结果并结合特征性发作表现,8例均明确诊断为癫痫复杂部分性发作,予抗癫痫治疗后发作均得以控制.结论 仅有意识障碍的癫痫复杂部分性发作易误诊,临床医生应依据典型临床表现并结合相关实验室检查（特别是脑电图检查）和治疗反应有助于确诊.

Misdiagnosis Analysis of 8 Patients with Complex Partial Seizure Only for Consciousness Disorders

Objective To analyze clinical characteristics and misdiagnosis causes of complex partial seizure only for consciousness disorders.Methods Clinical data of 8 misdiagnosed patients with complex partial seizure between January 2010 and December 2012 in our hospital was retrospectively analyzed.Results Clinical manifestations of the 8 patients were sudden interruption of ongoing activities with a blank stare,no response to voice command,without drop attacks,complexion change,without heteronomous and unconscious behaviour,with de novo of primary activity after attack.Every attack continued from several seconds to minutes with transient disorientation after attack.Three patients were misdiagnosed as having basilar-vertebral artery system of transient ischemic attack （TIA）,three were misdiagnosed as having syncope,and two were misdiagnosed as having typical absence seizures.The complex partial seizure epilepsy was confirmed in 8 patients by attack intermission of 24 h active EEG （AEEG）,which showed an attacking sharp wave or sharp-slow composite wave in bilateral anteromedial temporal area or frontal area,combined with the seizure characteristics.The patient＇s conditions were controlled after antiepileptic drugs （AEDs） treatment.Conclusion The complex partial seizure only for consciousness disorders may be misdiagnosed,and the final diagnosis depends on typical clinical manifestations combined with correlative laboratory examinations （especially EEG） and treatment response.