てんかんにおける局所性Dischargeと臨床発作との関連について

CORRELATION BETWEEN FOCAL SPIKE-DISCHARGE AND CLINICAL SEIZUERE IN EPILEPSY, ESPECIALLY IN REFER TO THE FRONTAL LOBE EPILEPSY

はじめに

　臨床脳波においては棘波spikeの発現はてんかんの一大特質であり，またこのことは現在大方に承認されている知見でもある。しかし，その一方，臨床的にてんかん症状をまつたく欠く場合にもspikeがみられたり，またはspikeの発現部位に直接関連がないてんかん性局所症状がみられたりするという具合に，我々は時に非合理的な所見にであうことがある。そこでてんかん性要因としての脳波spikeと臨床症状の相関を，比較的に症状が恒常ないわゆる前頭葉焦点てんかんを中心として，ここに改めて再検討してみようと考えた次第である。

　ちなみに前頭葉焦点てんかんを対象にしたのはひとつには次の理由にもよる。すなわち，かつて我々は多電極針の植込み電極埋没法によつて，精神分裂病者の前頭葉および視床部にそれぞれ単独ないしは同時に直接電気刺激を与え，いわゆるelectrostimographyを試みたことがあるが，その際，開発される臨床症状と脳波dischargeとの相関が，dischargeの伝播・波及といつた様相や刺激閾値の問題もふくむ種々の条件下で検討されなければならないことを知つたためでもある。

It has been recognized that an outburst of spike-discharge is a definite characteristic sign of epilepsy. However, especially in clini-cal field, sometimes such irrational cases have been seen that, in spite of spike in EEG, either there lack any clinical seizures or there are some inaccordance between clinical symp-toms to be expected and EEG-focus. Here the author has chosen 20 epileptic cases having definite EEG-focus in the frontal area and examined their clinical seizure patterns. The results from electrostimography applied to the frontal lobe and the thalamic part in schizophrenics, which had previously made by the author, were compared with those above-described findings.

There were many resemblances between them, especially in such symptoms as adver-sion, tonic-arrest state and loss of conscious-ness. However, the results due to electrostimo-graphy showed an occurence of subclinical symptom despite of outburst of spike-dischar-ge. Accordingly, the author has intended to emphasize that spike-discharge might be not always accompany clinical seizure and, there-fore, in case of experimental study attentions should be paid to not only the focal sign of spike-discharge but its spreading or basic mechanism progressed in the deep structure.