Frequency, prognosis and surgical treatment of structural abnormalities seen with magnetic resonance imaging in childhood epilepsy
Frequency, prognosis and surgical treatment of structural abnormalities seen with magnetic resonance imaging in childhood epilepsy
复制标题
DOI：
10.1093/brain/awp187
复制
发表时间：
2009-10-01
期刊：
影响因子：
14.5
通讯作者：
Levy, Susan R.
中科院分区：
文献类型：
--
作者：
Berg, Anne T.;Mathern, Gary W.;Levy, Susan R.
先前尚未描述过磁共振成像（MRI）识别的病变的流行病学，以及儿童期癫痫患者的手术前评估和手术的使用。沿着。在1993年至1997年招募的前瞻性确定的以社区为基础的儿童队列中，我们检查了（i）MRI确定的病变频率;（ii）与“阳性”MRI扫描相关的临床因素;（iii）综合癫痫评估和神经外科的利用。在最初的613名儿童中，518名（85%）有可用的MRI扫描。82例（16%）MRI异常可能与癫痫相关（“阳性”扫描）。特发性癫痫综合征确定在162（31%），其中3%有积极的扫描。其余的有非特发性癫痫综合征，其中22%有阳性MRI结果。多元逻辑回归分析确定非特发性癫痫和异常运动感觉（神经）检查作为阳性MRI扫描的预测因子。在神经系统检查正常且无耐药性的非特发性患者中，10%的患者MRI扫描呈阳性，包括4例神经胶质瘤患者。在综合性癫痫中心对54例耐药性病例进行了评价。迄今为止，5%的成像队列或8%的非特发性癫痫患者接受了外科手术（包括迷走神经刺激器植入），以治疗癫痫（n = 22）或肿瘤（n = 6），而没有耐药性。将我们的研究结果应用于美国的一般儿童人群，我们估计每年将有127/1000000例新的耐药性癫痫病例，52/1000000例儿童期发作的癫痫患者接受癫痫评估。此外，大约27/1000000将有癫痫相关的外科手术。这些发现支持使用MRI评估新诊断的儿童癫痫患者，特别是非特发性综合征的建议，并提供综合评估和手术的利用率估计。
The epidemiology of lesions identified by magnetic resonance imaging (MRI), along with the use of pre-surgical evaluations and surgery in childhood-onset epilepsy patients has not previously been described. In a prospectively identified community-based cohort of children enrolled from 1993 to 1997, we examined (i) the frequency of lesions identified by MRI; (ii) clinical factors associated with 'positive' MRI scans; and (iii) the utilization of comprehensive epilepsy evaluations and neurosurgery. Of the original cohort of 613 children, 518 (85%) had usable MRI scans. Eighty-two (16%) had MRI abnormalities potentially relevant to epilepsy ('positive' scans). Idiopathic epilepsy syndromes were identified in 162 (31%) of whom 3% had positive scans. The remainder had non-idiopathic epilepsy syndromes of which 22% had positive MRI findings. Multiple logistic regression analysis identified non-idiopathic epilepsy and abnormal motor-sensory (neurological) examinations as predictors of a positive MRI scan. Of the non-idiopathic patients with normal neurological exams and who were not pharmacoresistant, 10% had positive MRI scans, including four patients with gliomas. Evaluations at comprehensive epilepsy centres occurred in 54 pharmacoresistant cases. To date 5% of the imaged cohort or 8% of non-idiopathic epilepsy patients have undergone surgical procedures (including vagal nerve stimulator implantation) to treat their epilepsy (n = 22) or for tumours (n = 6) without being drug resistant. Applying our findings to the general population of children in the USA, we estimate that there will be 127/1 000 000 new cases per year of pharmacoresistant epilepsy, and 52/1 000 000 childhood-onset epilepsy patients undergoing epilepsy evaluations. In addition, approximately 27/1 000 000 will have an epilepsy-related surgical procedure. These findings support recommendations for the use of MRI in evaluating newly diagnosed paediatric epilepsy patients, especially with non-idiopathic syndromes, and provide estimates on the utilization of comprehensive evaluations and surgery.