青年期Adolescence初発てんかんの臨床

A STUDY ON ADOLESCENCE EPILEPSY

I．はじめに

　てんかんの発病を年齢別にみると，若年者ほどその発病率が高く，年齢が長ずるにつれて発病率が低下する傾向にあることは，すでによく知られているところである。弘前大学神経科での和田の資料^13）によると，1,500名の患者について，その81％が20歳以前に発病している。同様に，Lennox^7）は4,000例のてんかんについて19歳までに77％が発病しているという結果を示している。しかし，年齢とともに発病率が低下するというこの傾向も，決してなだらかなものではなく，思春期（Pu—berty）前後の時期に一つの高まりがみられる^2,7）。

　これまでに，弘前大学神経科を受診したてんかん患者を対象として，佐藤^10）が12歳までに発病した症例について，川口ら^6）が20歳以後に初発の患者について，おのおのその臨床と脳波所見の特徴を検討し，その結果を報告した。今回，われわれはこれら両群の中間の時期にあたる青年期Adolescence^※に初発したてんかん患者をとりあげ，この前・後の時期に発病した症例群と対比しつつ，これら患者での臨床的特徴を検討することを試みた。

In this study, clinico-electroencephalographical features of the epilepsy beginning in adolescence were investigated, in comparison with those in the childhood epilepsy and in the late-onset epilepsy which had been already reported. The subjects were 129 epileptic patients (74 male and 55 female) whose attacks began in the ages from 13 years old to 19, and the observation periods of their clinical courses were for over 3 years.

The distribution of the onset age of the epilepsy showed 2 peaks ; the highest peak in 14 years of the age and the lower peak in 18 and 19 years, and the bottom in 16 and 17 years.

Classifing the probable causes of epilepsy of the subjects, they consisted of 32 cases (25%) withexogenic factors, 11 cases (9%) with hereditary factor, 15 cases (12%) with both exogenic and hereditary and 71 cryptogenic cases (55%).

As to the seizure types, 112 cases (87%) of the subjects had a single type of seizure: 69 cases (53%) with grand mal only, 26 cases (20%) with focal seizure only and 17 cases (13%) with psycho-motor seizure only. The other patients (13%) had mixed type of seizure in which 2 or more types of seizure coexisted.

Among the 112 cases with single type of seizure, 96 patients had been examined in our department within one month after the onset of seizure. The authors reviewed the first examined EEGs cf these 96 cases. As the result, it was found that seizure discharges occurred in 37% of grand mal, in 31% of focal seizure, in 85% of psychomotor seizure, respectively. Although the localized findings of the seizure discharges were observed more often in focal seizure and in psychomotor seizure, theincidences of anterior temporal spike focus in the localized seizure discharges were 25% in grand mal, 57% in focal seizure and 100% in psychomotor seizure.

Among the subjects, the percentage of seizure-free cases was 56% in average: 66% in grand mal, 57% in focal seizure, 38% in psychomotor seizure and 32% in the mixed type of seizure.

As conclusions, in the adolescence epilepsy, the incidence of grand mal was higher than these in the childhood epilepsy and in the late-onset, and the seizure-free cases were observed with the highest rate in grand mal, as compared with those in the other 2 groups. On the other hand, from aspects of sex-ratio and of the incidences of psycho-motor seizure and of petit mal absence, it was suggested that the epilepsy in question was situated midway between the childhood epilepsy and the late-onset.