国际癫癎发作分类建议(2001年)在部分性发作中的应用

目的探讨国际抗癫联盟关于癫发作分类的建议(2001年)在部分性癫发作中的应用价值和特点。方法收集1996年6月至2004年10月在我院癫中心就诊,经过录像脑电监测捕捉到发作的128例部分性癫患者的发作情况,应用1981、2001年两种癫发作分类方案,由3位受过正规癫和脑电图训练的神经科医生进行分类。结果128例患者共检测到298次发作。按照1981年分类标准,97次(32%)属于简单部分性发作,105次(35%)为复杂部分发作,12次(4%)部分性发作难以准确划分为简单或者复杂性,81次(27%)为继发全面性发作,3次(1%)为部分性癫持续状态;应用2001年分类建议,有295次发作为自限性局灶性发作,其中67次(22%)为局灶性感觉性发作,140次(47%)为局灶性运动性发作,包括81次(27%)伴随颞叶自动症的局灶运动性发作,81次(27%)为继发全面性发作,3次为局灶性癫持续状态发作。2001年分类方案中,发作类型体现了特征性的临床症状,与发作期的癫性放电的解剖部位有紧密的对应,但是,高级皮层的发作症状在一定程度上受到了忽略。结论2001年国际癫发作分类体现了良好的发作症状、发作类型、解剖部位之间的联系,可以试用于临床,但需要进一步的完善。

Application and evaluation of the proposed classification for epileptic seizures by International League Against Epilepsy (2001) in patients with partial seizures

Objective To apply and evaluate the new Classification of Epileptic Seizures in a sample of focal seizures.Method We collected seizures from 128 patients with partial epilepsy at our epileptic center,and the seizures were recorded when they underwent routine or long time video-EEG monitoring for regular diagnostic evaluations or presurgical evaluations,then all seizures were classified by 3 neurologists using both 1981 and 2001 the International Classification based on the clinical data from video-EEG.Results All 298 seizures were reviewed,in which 97(32%) were classified as having "simple partial seizures",105(35%) as having "complex partial seizures" and 12(4%) were uncertain, 3(1%) were focal status epileptics.Using the new classification,these seizures were classified as follows: self-limited seizure 295(99%),including focal sensory seizures 67(22%),focal motor seizures 140(47%),and 3 were classified as epileptic status noted in the 1981 and 2001 Classification.In the 2001 Classification,there was a close relationship among ictal semiology,seizure classification and anatomic substrates,but the cognitive and psychic semiology were relatively neglected.Conclusions The 2001 Seizure Classification should be useful and reliable in partial seizures,and further development is needed.