Magnetic Resonance Imaging of Epilepsy in Multiple Sclerosis: A Case Control Study. Implications for Treatment Trials with 4-Aminopyridine
Magnetic Resonance Imaging of Epilepsy in Multiple Sclerosis: A Case Control Study. Implications for Treatment Trials with 4-Aminopyridine
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多发性硬化症癫痫的磁共振成像：病例对照研究。
DOI：
10.1177/135245859600100405
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发表时间：
1996
期刊：
影响因子：
--
通讯作者：
J. Valk
中科院分区：
文献类型：
--
作者：
L. Truyen;F. Barkhof;S. Frequin;C. Polman;H. Tobi;O. Hommes;J. Valk
采用磁共振（MR）成像对多发性硬化（MS）患者癫痫进行病例对照研究，以半定量评估皮质-皮质下病变负荷。在13对MS伴癫痫病例和MS不伴癫痫对照的样本中，我们发现病例的累积皮质-皮质下病变负荷在统计学上高于对照组（Wilcoxon，P=0.036）。病例组和对照组的总损伤负荷（皮质-皮质下加深部白色物质负荷）无显著差异（P > 0.1）。通过皮质-皮质下病变负荷≥20的比值比确定癫痫发作的相对风险为。8.8（χ2 = 5.23，P 0.025），大（> 1cm）皮质-皮质下病变的优势比为4.7（χ2 = 4.9，P < 0.05），而两种MR标准联合显示优势比为19.2（χ2 = 8.0，P < 0.005）。我们的结论是：首先，皮质-皮质下病变的存在部分解释了MS患者癫痫发作的发生;第二，由于病例和对照组之间的MR成像评分有很大的重叠，这些MR成像结果在个体患者管理或试验组织中的最终使用应取决于治疗的预期获益，如果获益仅为中等或未知，在使用降低癫痫阈值的药物（如4-氨基吡啶）的试验中，排除MR成像显示大量皮质-皮质下病变负荷的病例的谨慎方法似乎是合适的。
A case-control study of epilepsy in multiple sclerosis (MS) is presented using magnetic resonance (MR) imaging to semiquantitatively assess cortical-subcortical lesion load. In this sample of 13 pairs of cases with MS and epilepsy and controls with MS without epilepsy we found statistically higher cumulated cortical-subcortical lesion loads in the cases than in the controls (Wilcoxon, P=0.036). Total lesion loads (cortical-subcortical plus deep white matter loads) did not differ significantly (P > 0.1) between cases and controls. The relative risk for seizures as determined by the odds ratio of a cortical-subcortical lesion load of ≥20 was. 8.8 (χ2 = 5.23, P 0.025), the odds ratio of a large (> 1 cm) cortico-subcortical lesion was 4.7 (χ2 = 4.9, P < 0.05), while the 2 MR criteria combined show an odds ratio of 19.2 (χ2 = 8.0, P < 0.005). We conclude that first, the presence of cortical-subcortical lesions in part accounts for the occurrence of seizures in MS patients; second, due to the substantial overlap of MR imaging scores between cases and controls the ultimate use of these MR imaging findings in the management of individual patients or in the organizations of trials should depend on the expected benefit of the treatment If the benefit is only moderate or not known a cautious approach with exclusion of cases showing a substantial cortical-subcortical lesion load on MR imaging seems appropriate in trials with drugs, like 4-aminopyridine, that lower the epileptic threshold.