排尿時に意識消失発作をきたす疾患群の臨床病態生理学的研究—排尿によって誘発されるテンカン発作について（第3報）

THE CLINICAL AND PHYSIOLOGICAL STUDIES IN PATIENTS INDUCED UNCONSCIOUSNESS FOLLOWING MICTURITION: 3. EPILPTIC SEIZURES TRIGGERED BY MICTURITION

I．はじめに

　排尿に関連して，意識消失痙攣精神運動発作などを惹起する症例32名を検討し，すでにMicturition Syn—cope群とShy-Drager症候群については報告した^9,10）。

　今回は，32例中23例（71.9％）をしめるテンカン群について検討したので報告する。テンカン群における問題点は，排尿とテンカン発作とがかならず相関するいわゆる反射テンカンに類似する症例があるか否かということ，つぎに，排尿のような自律神経からの求心性インパルスが発作にいかに関与し，かつ，それに何らかの特徴があるかどうかということであり，これらの問題について若干の考察を行なつた。

Previously reported twenty three epileptics, whoinduced unconsciousness, convulsion or psychomotorattack following urination, were examined clinicallyand physiologically.

Usual seizures in these twenty three epilepticswere classified into generalized seizures (6 cases,26.1%), partial seizures with elementary symptom-atology (6 cases, 26.1%), partial seizures with coinplex symptomatology (7 cases, 30.4%) and partialseizures secondarily generalized (4 cases, 17.4%).

The seizures in these epileptics following micturi-tion were convuisive seizures (5 cases), arrests ofconsciousness (12 cases), convulsive seizures andarrests of consciousness (3 cases), and psychomotorseizures (3 cases). The case of epilepsy in whichseizures were induced only following urination hadnot been observed, but the seizures in three epilep-tics were triggered frequently by the micturition.In two cases of 23 epileptics the seizures occurredbefore the urination, and the seizures in the 21 caseswere induced about one or two minutes after theend of urination. The conditions of patients pre-ceding the attacks were imediately after the awak-ening from sleep or under the state of frequentoccurrence of epileptic seizures.

In order to observe how the micturition partici-pates in the cortical activation, we carried outfollowing experiments. The EEG had been recordedon the patient cannulated with the balloon catheterwho was in the state of sleep by the intramuscularinjection of diphenhydramine, and the sterilizedwater was infused into the urinary bladder throughthe balloon catheter. The distension of urinarybladder served as an acute trigger to the desynchro-nization of EEG, and following the withdrawal offluid, the sleep pattern of EEG reappeared in amoment. It is suggested from the present resultsthat afferent impulses elicited by the urinary blad-der distension participate powerfully in the cerebralactivation.

From the clinical and experimental results, it isconcluded that most epileptic seizures triggered bythe micturition are not directly induced by theafferent impulses from the distended bladder, butare triggered by the acute removal of the afferentimpulses from the bladder following the micturitionwhich causes the failure in maintaining the corticalactivation mechanism sustained more dominantlyby the afferent impulses from the distended urinarybladder than other sensory impulses.