Yücel Oya, Aka Sibel, Yazicioglu Levent, Ceran Omer
Haydarpasa Numune Training and Research Hospital, Pediatrics Clinic, Istanbul, Turkey.
Pediatr Int. 2004 Aug;46(4):463-7. doi: 10.1111/j.1328-8067.2003.01799.x.
The present study investigates the role of early use of EEG in children with no known neuropathology prior to the first CFS, and the contribution made by computed tomography (CT) and magnetic resonance imaging (MRI) to treatment and prognosis.
Over a period of 7 years, the authors evaluated 159 children (age range: 2 months-5 years) who were being treated for CFS at Haydarpasa Numune Training and Research Hospital, Pediatrics Clinic, Istanbul, Turkey, and who had no previously known neurological disorder. Patients who presented with febrile seizure were determined to have CFS if they fulfilled the following criteria: <3 months of age when seizure occurred, duration of seizure >/=15 min, more than one seizure occurred during a single episode of illness, or focal seizures and postictal neurological deficit was found. EEG was performed on all patients. CT was performed on the patients who had postictal neurologic deficit or focal seizures. Cranial MRI was performed on patients who had focal findings in their EEGs.
Electroencephalogram abnormality was found in 71 cases; 51 of these were diagnosed with epilepsy during follow up. Six of the 16 cases whose EEGs were abnormal between days 2 and 6 were diagnosed with epilepsy. Twenty of the 30 cases whose EEGs were abnormal between days 7 and 10 were diagnosed with epilepsy. All 25 cases who had abnormal EEGs after day 11 were diagnosed with epilepsy. CT was performed for 36 patients, of which five were found to have pathological changes. Pathological changes were detected in two of the nine patients who had cranial MRI. Patients who received CT or MRI were all diagnosed with epilepsy during follow up.
The results suggest that if neurological examination of CFS patients are normal after their clinical status has stabilised, EEG should be performed after 7 days at the earliest, however for the most accurate diagnosis EEG should be performed 10 days after CFS. The most important predictor for neuroimaging was found to be detection of postictal neurologic deficit. MRI had no advantages over CT in first treating CFS in the emergency unit.
本研究调查了在首次慢性疲劳综合征（CFS）发作前无已知神经病理学改变的儿童早期使用脑电图（EEG）的作用，以及计算机断层扫描（CT）和磁共振成像（MRI）对治疗和预后的贡献。
在7年的时间里，作者评估了159名儿童（年龄范围：2个月至5岁），这些儿童在土耳其伊斯坦布尔海达尔帕萨努穆内培训和研究医院儿科诊所接受CFS治疗，且之前无已知神经系统疾病。出现热性惊厥的患者如果符合以下标准则被判定为患有CFS：惊厥发作时年龄<3个月，惊厥持续时间>/=15分钟，单次疾病发作期间出现不止一次惊厥，或发现局灶性惊厥和惊厥后神经功能缺损。对所有患者进行了EEG检查。对有惊厥后神经功能缺损或局灶性惊厥的患者进行了CT检查。对EEG有局灶性表现的患者进行了头颅MRI检查。
71例患者发现脑电图异常；其中51例在随访期间被诊断为癫痫。在第2天至第6天脑电图异常的16例患者中有6例被诊断为癫痫。在第7天至第10天脑电图异常的30例患者中有20例被诊断为癫痫。第11天后脑电图异常的所有25例患者均被诊断为癫痫。对36例患者进行了CT检查，其中5例发现有病理改变。在进行头颅MRI检查的9例患者中有2例检测到病理改变。接受CT或MRI检查的患者在随访期间均被诊断为癫痫。
结果表明，如果CFS患者临床状况稳定后神经系统检查正常，脑电图最早应在7天后进行，但为了最准确的诊断，脑电图应在CFS发作10天后进行。发现神经影像学检查的最重要预测指标是惊厥后神经功能缺损的检测。在急诊室首次治疗CFS时，MRI与CT相比没有优势。
