Asano Eishi, Pawlak Carol, Shah Aashit, Shah Jagdish, Luat Aimee F, Ahn-Ewing Judy, Chugani Harry T
Department of Pediatrics, Children's Hospital of Michigan, Detroit Medical Center, Wayne State University, Detroit, MI 48201, USA.
Epilepsy Res. 2005 Aug-Sep;66(1-3):129-35. doi: 10.1016/j.eplepsyres.2005.07.012.
We retrospectively reviewed the clinical utility of initial video-EEG monitoring in a series of 1000 children suspected of epileptic disorders.
The ages of patients (523 boys and 477 girls) ranged from 1 month to 17 years (median age: 7 years). The mean length of stay was 1.5 days (range: 1-10 days). Outcomes were classified as: 'useful-epileptic' (successful classification of epilepsy), 'useful-nonepileptic' (demonstration of nonepileptic habitual events), 'uneventful' (normal EEG without habitual events captured), and 'inconclusive' (inability to clarify the nature of habitual events with abnormal interictal EEG findings).
A total of 315 studies were considered 'useful-epileptic'; 219 'useful-nonepileptic'; 224 'uneventful'; 242 'inconclusive'. Longer monitoring was associated with higher rate of a study classified as 'useful-epileptic' in all age groups (Chi square test: p<0.001). In addition, longer monitoring was associated with lower rate of a study classified as 'inconclusive' in adolescences (p<0.001). Approximately half of the children with successful classification of epilepsy were assigned a specific diagnosis of epilepsy syndrome according to the International League Against Epilepsy (ILAE) classification. We found only 22 children with ictal EEG showing a seizure onset purely originating from a unilateral temporal region.
Video-EEG monitoring may fail to capture habitual episodes. To maximize the utility of studies in the future, a video-EEG monitoring longer than 3 days should be considered in selected children such as adolescences with habitual events occurring on a less than daily basis. We recognize a reasonable clinical utility of the current ILAE classification in the present study. It may not be common to identify children with pure unilateral temporal lobe epilepsy solely based on video-EEG monitoring.
我们回顾性分析了1000例疑似癫痫疾病儿童的初始视频脑电图监测的临床效用。
患者年龄（523名男孩和477名女孩）从1个月至17岁不等（中位年龄：7岁）。平均住院时间为1.5天（范围：1 - 10天）。结果分为：“有用 - 癫痫性”（癫痫成功分类）、“有用 - 非癫痫性”（非癫痫习惯性事件的证实）、“无异常”（未捕捉到习惯性事件的正常脑电图）和“不确定”（无法通过发作间期脑电图异常结果明确习惯性事件的性质）。
共有315项研究被认为是“有用 - 癫痫性”；219项“有用 - 非癫痫性”；224项“无异常”；242项“不确定”。在所有年龄组中，监测时间越长，被分类为“有用 - 癫痫性”的研究比例越高（卡方检验：p < 0.001）。此外，在青少年中，监测时间越长，被分类为“不确定”的研究比例越低（p < 0.001）。根据国际抗癫痫联盟（ILAE）分类，约一半癫痫成功分类的儿童被指定为特定的癫痫综合征诊断。我们仅发现22名儿童的发作期脑电图显示癫痫发作起始纯粹源自单侧颞叶区域。
视频脑电图监测可能无法捕捉到习惯性发作。为了在未来最大限度地提高研究效用，对于某些儿童，如习惯性发作少于每日一次的青少年，应考虑进行超过3天的视频脑电图监测。我们认识到当前ILAE分类在本研究中的合理临床效用。仅基于视频脑电图监测识别出单纯单侧颞叶癫痫的儿童可能并不常见。
