癫癎自动症的诊断和定位价值

目的　分析癫自动症的临床和脑电图特征。方法　对 12 1例癫自动症患者的临床、神经影像学和脑电图特征进行分析。结果　 12 1例患者中男 72例 ,女 4 9例 ,年龄 1～ 6 8岁 ,平均年龄 2 6岁 ;病程 0 2 5～ 5 6年 ,平均病程 11年。临床表现主要包括咂嘴、吞咽、双手摸索、游走、自言自语、不自主哭笑、摸鼻子、打人、蹲起等 ,持续数秒至十几分钟。发作间期脑电图表现为局灶性或多灶性尖波、尖慢波综合以及慢波节律 ,以颞、额、枕叶为主 ;发作期性放电明显增多 ,可向周围部位传播。口咽自动症无定位价值 ,言语自动症大多起源于非优势半球 ,姿势性自动症和不自主哭笑的发生在额叶癫 (分别为 5例、3例 )和颞叶癫 (分别为 0和 7例 )中有统计学差异 (P <0 0 5 )。结论　自动症是多种类型的癫发作所共有的特征 ,诊断必须结合其他临床症状和脑电图表现才能予以明确。

Diagnosis and localizing significance of automatism seizure

Objective To investigate the clinical and electroencephalographic characteristics of automatism.Methods Automatisms and findings on EEG and neuroimaging in 121 patients with different types of epilepsy were analyzed to establish a possible correlation between the type of automatism and the cerebral localization.Results Of 121 patients with automatism,72 were male and 49 were female aged 1 to 68 years (average 26.13 years). Duration of epilepsy was 0.25 to 56 years (average 11.28 years). Its most frequent ictal manifestations included lip smacking,swallowing,aimless hand movements,ambulatory,repetition of a single word,weeping and smiling,nose-rubbing,or swinging,or sitting-standing up with or without alteration of consciousness,etc,whose duration ranged from some seconds to more than ten minutes. The interictal EEG showed paroxysmal sharp waves,spike and waves or rhythmic slow waves in temporal lobe, frontal lobe or occipital lobe,which occasionally spreading to parietal lobe and obviously increased during seizure. These signs displayed oroalimentary automatism which did not predict focus lateralization,however,the verbal automatism mostly showed focus contralateral to their language-dominant hemisphere. Statistically significant differences in gestural automatism and weeping or smiling were noted between frontal lobe epilepsy and temporal lobe epilepsy (5 vs 0 and 3 vs 7,respectively,P <0.05).Conclusion The automatisms should be not exclusive of temporal seizures and may be observed in frontal epilepsy and occipital epilepsy. Other clinical features and if needed,repetitive electroencephalographs are warranted for proper diagnosis.