Berg A T, Testa F M, Levy S R, Shinnar S
Northern Illinois University Department of Biological Sciences, DeKalb, Illinois 60115, USA.
Pediatrics. 2000 Sep;106(3):527-32. doi: 10.1542/peds.106.3.527.
Neuroimaging is generally considered a part of the evaluation of seizures and epilepsy. There is limited information about its current use in the initial evaluation of pediatric epilepsy and about its yield during the initial diagnosis of epilepsy. We describe the patterns in the use and yield of diagnostic imaging in children with newly diagnosed epilepsy in a community-based study.
Children were recruited when first diagnosed with epilepsy by participating physicians in Connecticut (1993-1997). Definitions for etiology and underlying epilepsy syndromes are as published by the International League Against Epilepsy.
Of 613 children, 488 (79.6%) had imaging: 388 (63. 3%) magnetic resonance imaging, 197 (32.1%) computed tomography scans, and 97 (15.8%) both. Half of children with idiopathic generalized epilepsy had imaging studies compared with 70% to 100% of children with other forms of epilepsy, depending on the specific type. Etiologically relevant abnormalities were found in 62 (12.7% of those imaged). Fourteen of these children had otherwise completely normal presentations and histories. Their abnormalities included tuberous sclerosis (N = 4), tumors (N = 2), an arteriovenous malformation later diagnosed as a tumor, a cavernous angioma, cerebral malformations (N = 3), and other abnormalities (N = 3). Thirteen of the 14 had partial seizures and 12 had focal electroencephalographic (EEG) findings. Only 1 had neither.
In children with newly diagnosed epilepsy, neuroimaging reveals a small but significant number of serious abnormalities not previously suspected. Most of these children have partial seizures or focal EEG abnormalities. Neuroimaging should be considered during the evaluation of children with newly diagnosed epilepsy, especially for those with neurologic deficits or partial seizures or focal EEG abnormalities that are not part of an idiopathic localization-related epilepsy syndrome.
神经影像学通常被视为癫痫发作和癫痫评估的一部分。目前关于其在小儿癫痫初始评估中的应用情况以及在癫痫初步诊断时的检出率的信息有限。我们在一项基于社区的研究中描述了新诊断癫痫患儿诊断性影像学检查的使用模式和检出率。
康涅狄格州的参与医师首次诊断出癫痫的儿童被纳入研究（1993 - 1997年）。病因和潜在癫痫综合征的定义如国际抗癫痫联盟所公布。
613名儿童中，488名（79.6%）进行了影像学检查：388名（63.3%）进行了磁共振成像，197名（32.1%）进行了计算机断层扫描，97名（15.8%）两者都做了。特发性全身性癫痫患儿中有一半进行了影像学检查，而其他形式癫痫的患儿这一比例为70%至100%，具体取决于癫痫的特定类型。在进行影像学检查的患儿中，有62名（12.7%）发现了与病因相关的异常。其中14名儿童在其他方面表现和病史完全正常。他们的异常包括结节性硬化症（4例）、肿瘤（2例）、后来被诊断为肿瘤的动静脉畸形、海绵状血管瘤、脑畸形（3例）以及其他异常（3例）。这14名儿童中有13名有部分性发作，12名有局灶性脑电图（EEG）表现。只有1名既没有部分性发作也没有局灶性EEG表现。
在新诊断的癫痫患儿中，神经影像学检查发现了少量但数量可观的此前未被怀疑的严重异常。这些儿童大多数有部分性发作或局灶性EEG异常。在评估新诊断的癫痫患儿时应考虑进行神经影像学检查，特别是对于那些有神经功能缺损、部分性发作或不属于特发性局灶性癫痫综合征的局灶性EEG异常的患儿。
