Epilepsy prevalence and severity predictors in MRI-identified focal cortical dysplasia
Epilepsy prevalence and severity predictors in MRI-identified focal cortical dysplasia
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DOI：
10.1016/j.eplepsyres.2017.03.001
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发表时间：
2017-05-01
影响因子：
2.2
通讯作者：
Greiner, Hansel M.
中科院分区：
文献类型：
--
作者：
Maynard, Lauren M.;Leach, James L.;Greiner, Hansel M.
目的：了解磁共振成像(MRI)确诊的局灶性皮质发育不良(FCD)患儿中癫痫和耐药癫痫的发生率。目的：通过对医院放射学数据库中的关键字进行关键词搜索，确定纳入这项回顾性研究的97名研究对象，以确定在MRI识别的功能性脑脊髓炎患儿中，耐药癫痫、药物反应性癫痫和无癫痫的儿童之间的临床和影像差异。如果参与者在数据库查询时未满18岁，并且在2004年至2013年期间进行了显示FCD的磁共振成像，则包括在内。根据影像和临床特点排除。通过图表回顾和补充问卷收集数据。结果：在这组影像表现与FCD相符的患者中，29%的人没有发生癫痫。癫痫和耐药癫痫的患病率分别为71.13%(95%C.I.=61.05-79.89%)和32.99%(95%C.I.=23.78-43.27%)。有癫痫的患者比无癫痫的患者更有可能有颞叶(p=0.029)或额叶(p=0.044)病变和癫痫家族史(p=0.003)。药物敏感型癫痫患者的癫痫发作年龄较耐药型癫痫患者晚(p=0.0002)。发病年龄较晚(OR=1.22，p=0.0441，95%C.I.=1.00-1.486)和无发育迟缓(OR=3.624，p=0.0497，95%C.I.=1.002-13.110)预示癫痫表型较轻。结论：以往的研究仅评估了FCD和癫痫患者队列，限制了“无症状”或“不典型表现”FCD的数据。确定一个令人惊讶的大规模的、新的FCD儿童队列，这些儿童没有发生癫痫，有助于确定预后，并为FCD儿童的临床治疗提供信息。(C)2017爱思唯尔B.V.保留所有权利。
Objectives: To determine the prevalence of epilepsy and drug-resistant epilepsy in pediatric patients with focal cortical dysplasia (FCD) identified by magnetic resonance imaging (MRI). To determine clinical and imaging differences between those with drug-resistant epilepsy, drug-responsive epilepsy, and no epilepsy among children with MRI-identified FCD.Methods: A keyword search of a hospital radiology database identified 97 study participants for inclusion in this retrospective study. Participants were included if they were under 18 years of age at time of database query and had an MRI between 2004 and 2013 showing FCD. Exclusion was based on imaging and clinical characteristics. Data was gathered using a chart review and supplemental questionnaire.Results: In this cohort of patients with imaging findings compatible with FCD, 29% had not developed epilepsy. The prevalence of epilepsy and drug-resistant epilepsy was 71.13% (95% C.I. = 61.05-79.89%) and 32.99% (95% C.I. = 23.78-43.27%), respectively. Patients with epilepsy were more likely to have temporal (p = 0.029) or frontal (p = 0.044) lobe lesions and a family history of seizures (p = 0.003) than those without epilepsy. Age of seizure onset was later in those with drug-responsive epilepsy than those with drug resistant epilepsy (p = 0.0002). A later age of seizure onset (OR= 1.22,p = 0.0441, 95% C.I. = 1.00-1.486) and absence of developmental delay (OR = 3.624, p = 0.0497, 95% C.I. = 1.002-13.110) predicted a less severe epilepsy phenotype.Conclusions: Previous studies have only assessed patient cohorts with FCD and epilepsy, limiting the data on "asymptomatic" or "atypically presenting" FCD. Identifying a surprisingly large, novel cohort of children with FCD that had not developed epilepsy helps define prognosis and inform clinical management of children with FCD on imaging. (C) 2017 Elsevier B.V. All rights reserved.