Shinnar S, O'Dell C, Mitnick R, Berg A T, Moshe S L
Department of Neurology, Montefiore Medical Center, The Albert Einstein College of Medicine, Bronx, NY, USA.
Epilepsy Res. 2001 Mar;43(3):261-9. doi: 10.1016/s0920-1211(00)00206-0.
To determine the incidence and type of neuroimaging abnormalities in children presenting with a first seizure.
In a prospective observational study, 411 children with a first afebrile seizure were seen between 1983 and 1992. Imaging studies were performed in 218 (53%). For this analysis we examined the most sensitive neuroimaging study performed which included 159 computed tomography scans and 59 magnetic resonance imagings (MRI).
Four children were found to have lesions requiring intervention (brain tumor in two, neurocysticercosis in two). The remaining 407 were enrolled in a follow-up study of children with a first unprovoked seizure. After a mean follow-up of >10 years, none have developed clinical evidence of a tumor. In these 411 children, 45 (21%) of 218 imaging studies were abnormal. The most common abnormalities were focal encephalomalacia (n=16) and cerebral dysgenesis (n=11). Although children with partial seizures were more likely to be imaged (64%) than children with generalized seizures (43%) (P<0.001), the fraction of abnormal imaging studies was similar in both groups. Six children with a normal neurological examination who were initially classified as cryptogenic were subsequently found to have errors of cerebral migration on MRI. The incidence of lesions requiring acute intervention in children presenting with a first seizure is low. A significant proportion will have neuroimaging abnormalities particularly on MRI.
Neuroimaging should be considered in any child with a first seizure who does not have an idiopathic form of epilepsy.
确定首次发作的儿童神经影像学异常的发生率及类型。
在一项前瞻性观察研究中，1983年至1992年间诊治了411例首次无热惊厥儿童。其中218例（53%）进行了影像学检查。本次分析中，我们检查了所进行的最敏感的神经影像学检查，包括159例计算机断层扫描和59例磁共振成像（MRI）。
发现4例患儿有需要干预的病变（2例为脑肿瘤，2例为神经囊尾蚴病）。其余407例纳入首次无诱因惊厥儿童的随访研究。平均随访超过10年后，无患儿出现肿瘤的临床证据。在这411例儿童中，218例影像学检查中有45例（21%）异常。最常见的异常为局灶性脑软化（n = 16）和脑发育异常（n = 11）。尽管部分性发作儿童比全身性发作儿童接受影像学检查的可能性更大（64%对43%）（P<0.001），但两组影像学检查异常的比例相似。6例神经系统检查正常、最初分类为隐源性的患儿，随后在MRI上发现有脑移行异常。首次发作儿童中需要紧急干预的病变发生率较低。相当一部分患儿会有神经影像学异常，尤其是MRI检查。
任何首次发作且非特发性癫痫形式的儿童都应考虑进行神经影像学检查。
