A population-based study of newly diagnosed epilepsy in infants
A population-based study of newly diagnosed epilepsy in infants
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DOI：
10.1111/epi.12046
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发表时间：
2013-03-01
期刊：
影响因子：
5.6
通讯作者：
Cross, J. Helen
中科院分区：
文献类型：
--
作者：
Eltze, Christin M.;Chong, Wui K.;Cross, J. Helen
目的：大多数已发表的癫痫婴儿数据来自医院/专科诊所，因此可能不代表一般人群。我们进行了一项基于人群的研究，以估计婴儿癫痫发作的发病率，表征表型和相关脑结构异常的范围，并确定是否可以在发作时建立特定的癫痫诊断。研究方法：从北伦敦15个区的居民中确定了13个月以上1 ~ 24个月的新发癫痫儿童。基于临床信息、脑电图（EEG）和神经影像数据的分类由两位儿科神经科医生独立进行。神经影像由两名对临床细节不知情的神经放射科医生进行审查。主要发现：共入组了57名儿童，确定校正的发生率为70.1（95% CI [56.3，88.5]）/100，000名2岁/年的儿童（确定76%）。亚裔儿童的发病率最高。在24例（42%）病例中确定了电临床综合征，其中21例为癫痫性脑病。回顾了51例（占总队列的89%）的磁共振（MR）图像。这些在51例病例中的37例（72%）中表现出阳性结果，其中26例（51%）与病因相关，包括11例（21%）发育畸形。重要性：在人群中，婴儿发作的癫痫大多表现为复杂的表型，通常与脑结构异常相关。因此，就诊时进行常规MR成像是合理的。然而，在发病时识别特定的电临床综合征仍然很困难。
Purpose: Most published data on infants presenting with epilepsy originate from hospital/specialist clinic settings and may therefore not be representative of the general population. We carried out a population-based study to estimate the incidence of epilepsy onset in infants, to characterize the range of phenotypes and associated structural brain abnormalities, and to determine whether specific epilepsy diagnoses could be established at onset. Methods: Children between 1 and 24months of age with new-onset epilepsy were ascertained over 13months from the residents in 15 boroughs of North London. Classification based on clinical information, electroencephalography (EEG), and neuroimaging data was undertaken independently by two pediatric neurologists. Neuroimages were reviewed by two neuroradiologists blinded to clinical details. Key Findings: A total of 57 children were enrolled giving an ascertainment-adjusted incidence of 70.1 (95% CI [56.3, 88.5])/100,000 children 2years of age/year (ascertainment 76%). The incidence was highest among Asian children. An electroclinical syndrome was identified in 24 (42%) cases of which 21 were epileptic encephalopathies. Magnetic resonance (MR) images of 51 cases (89% of the total cohort) were reviewed. These demonstrated positive findings in 37 (72%) of 51 cases, of which 26 (51%) of 51 were etiologically relevant, and included developmental malformations in 11 (21%) of 51. Significance: In a population setting infantile onset epilepsy presents mostly with complex phenotypes commonly associated with structural brain abnormalities. Routine MR imaging at presentation is therefore justified. However, identification of specific electroclinical syndromes remains difficult at onset.