Bernal Byron, Altman Nolan R
Department of Radiology, Miami Children's Hospital, 3100 SW 62nd Avenue, Miami, FL 33155, USA.
Neuroimaging Clin N Am. 2003 May;13(2):211-24. doi: 10.1016/s1052-5149(03)00019-4.
Evidence-based medicine is useful in epilepsy and neuroimaging (Figs. 1 and 2). An understanding of the pretest probability suggests that focal neurologic deficits are important in predicting the outcome of neuroimaging examinations. In cases of nonacute symptomatic seizures, confusion and postictal deficits should prompt MR evaluation. In remote symptomatic seizures, MR imaging should be performed in a child with unexplained cognitive or motor delays or a child less than 1 year of age. Patients with partial seizures, abnormal EEG, or generalized epilepsy also should be imaged. Acute seizures should be imaged with CT to exclude hemorrhage and because of the availability and speed of the modality. Ictal SPECT is the best neuroimaging examination to localize seizure activity. MR imaging can offer prediction of surgical outcome and may hold promise in the future for dimensional localization of seizure focus. Evidence-based medicine can only work if there is physician communication. The pretest probability is helpful only when an accurate history is provided to the consulting physician. This field will flourish if physicians can develop accurate methods of collating information and reporting it in a timely fashion in the literature.
循证医学在癫痫和神经影像学中很有用（图1和图2）。对检查前概率的理解表明，局灶性神经功能缺损在预测神经影像学检查结果方面很重要。在非急性症状性癫痫病例中，意识模糊和发作后缺损应促使进行磁共振成像（MR）评估。在远隔症状性癫痫中，对于有无法解释的认知或运动发育迟缓的儿童或1岁以下儿童，应进行MR成像检查。部分性癫痫、脑电图异常或全身性癫痫患者也应进行成像检查。急性癫痫发作应进行CT成像，以排除出血，且鉴于该检查方式的可用性和速度。发作期单光子发射计算机断层扫描（SPECT）是定位癫痫发作活动的最佳神经影像学检查。MR成像可以预测手术结果，并且在未来可能有望实现癫痫病灶的三维定位。只有当医生进行沟通时，循证医学才能发挥作用。只有向会诊医生提供准确的病史，检查前概率才会有帮助。如果医生能够开发出准确的信息整理方法并及时在文献中报告，这个领域将会蓬勃发展。
