Department of Biology, Northern Illinois University, DeKalb, IL 60115, USA.
Brain. 2009 Oct;132(Pt 10):2785-97. doi: 10.1093/brain/awp187. Epub 2009 Jul 28.
The epidemiology of lesions identified by magnetic resonance imaging (MRI), along with the use of pre-surgical evaluations and surgery in childhood-onset epilepsy patients has not previously been described. In a prospectively identified community-based cohort of children enrolled from 1993 to 1997, we examined (i) the frequency of lesions identified by MRI; (ii) clinical factors associated with 'positive' MRI scans; and (iii) the utilization of comprehensive epilepsy evaluations and neurosurgery. Of the original cohort of 613 children, 518 (85%) had usable MRI scans. Eighty-two (16%) had MRI abnormalities potentially relevant to epilepsy ('positive' scans). Idiopathic epilepsy syndromes were identified in 162 (31%) of whom 3% had positive scans. The remainder had non-idiopathic epilepsy syndromes of which 22% had positive MRI findings. Multiple logistic regression analysis identified non-idiopathic epilepsy and abnormal motor-sensory (neurological) examinations as predictors of a positive MRI scan. Of the non-idiopathic patients with normal neurological exams and who were not pharmacoresistant, 10% had positive MRI scans, including four patients with gliomas. Evaluations at comprehensive epilepsy centres occurred in 54 pharmacoresistant cases. To date 5% of the imaged cohort or 8% of non-idiopathic epilepsy patients have undergone surgical procedures (including vagal nerve stimulator implantation) to treat their epilepsy (n = 22) or for tumours (n = 6) without being drug resistant. Applying our findings to the general population of children in the USA, we estimate that there will be 127/1 000 000 new cases per year of pharmacoresistant epilepsy, and 52/1 000 000 childhood-onset epilepsy patients undergoing epilepsy evaluations. In addition, approximately 27/1 000 000 will have an epilepsy-related surgical procedure. These findings support recommendations for the use of MRI in evaluating newly diagnosed paediatric epilepsy patients, especially with non-idiopathic syndromes, and provide estimates on the utilization of comprehensive evaluations and surgery.
磁共振成像（MRI）所识别的病变的流行病学，以及在儿童期起病的癫痫患者中使用术前评估和手术，以前尚未描述过。在 1993 年至 1997 年期间，我们从一个前瞻性确定的基于社区的儿童队列中进行了检查：（i）通过 MRI 识别病变的频率；（ii）与“阳性”MRI 扫描相关的临床因素；以及（iii）全面的癫痫评估和神经外科手术的使用。在最初的 613 名儿童队列中，有 518 名（85%）有可用的 MRI 扫描。82 名（16%）有潜在与癫痫相关的 MRI 异常（“阳性”扫描）。在 162 名（31%）特发性癫痫综合征患者中确定了特发性癫痫综合征，其中 3%的患者有阳性扫描结果。其余患者患有非特发性癫痫综合征，其中 22%的患者有阳性 MRI 发现。多变量逻辑回归分析确定非特发性癫痫和异常运动感觉（神经）检查是阳性 MRI 扫描的预测因素。在非特发性患者中，有正常神经系统检查且无药物抵抗的患者中，有 10%的患者有阳性 MRI 扫描，其中包括 4 名患有神经胶质瘤的患者。在 54 例药物抵抗病例中进行了全面的癫痫中心评估。迄今为止，成像队列的 5%或非特发性癫痫患者的 8%（n = 22）接受了手术治疗（包括迷走神经刺激器植入）来治疗其癫痫或肿瘤（n = 6）而无需药物抵抗。将我们的发现应用于美国一般人群中的儿童，我们估计每年将有 127/1000000 例新的耐药性癫痫病例，以及 52/1000000 例儿童期起病的癫痫患者接受癫痫评估。此外，大约 27/1000000 将有与癫痫相关的手术。这些发现支持在评估新诊断的儿科癫痫患者时使用 MRI 的建议，特别是对于非特发性综合征患者，并提供了全面评估和手术利用的估计。
