Sinha Sanjib, Satishchandra Parthasarathy, Kalband Balaji Rameshrao, Bharath Rose Dawn, Thennarasu Kandavel
Department of Neurology, National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India.
Ann Indian Acad Neurol. 2012 Oct;15(4):273-80. doi: 10.4103/0972-2327.104335.
The occurrence of epilepsy is higher among elderly patients. The clinical manifestations of seizures, causes of epilepsy, and choice of anti-epileptic drugs (AEDs) are different in elderly people with epilepsy compared to the young.
To evaluate the imaging (CT/MRI) observations in elderly patients manifesting with new-onset seizures.
Two hundred and one elderly patients with new onset seizures, >60 years (age: 68.0 ± 7.5 years; M:F = 1.8:1) from Jan' 07 to Jan' 09, were prospectively recruited. Observations of cranial CT scan (n = 201) and MR imaging (n = 43) were analyzed.
THE TYPE OF SEIZURES INCLUDED: Simple partial (42%), generalized tonic-clonic (30.3%), and complex partial (27.4%). The pattern of epilepsy syndromes were acute symptomatic (42.3%), remote symptomatic (18.4%), cryptogenic (37.8%), and idiopathic (1.5%). Seizures were controlled with monotherapy in 85%. The CT scan (n = 201) revealed cerebral atrophy (139), mild (79), moderate (43), and severe (18); focal lesions (98), infarcts (45), hemorrhages (18), granuloma (16), tumor (15) and gliosis (4), and hemispheric atrophy (1), white matter changes (75) and diffuse edema (21). An MRI (n = 43) showed variable degree of cerebral atrophy (31); white matter changes (20); focal cerebral lesions (24); - infarct (7); intracranial hemorrhage (6); granuloma (5); tumor (6); gliosis (1); hemispheric atrophy (1); and prominent Virchow-Robin spaces (7); and UBOs (12). Patients with focal lesions in neuroimaging more often had partial seizures, symptomatic epilepsy, past stroke, focal deficit, absence of diffuse atrophy, focal EEG slowing, abnormal CSF, seizure recurrence at follow-up (P < 0.05).
Brain imaging observations in elderly patients with new-onset seizures revealed underlying symptomatic nature, hence the etiology and thereby assisted in deciding the specific therapy.
老年患者癫痫的发生率较高。与年轻人相比，老年癫痫患者的癫痫发作临床表现、病因及抗癫痫药物（AEDs）的选择有所不同。
评估新发癫痫发作老年患者的影像学（CT/MRI）表现。
前瞻性纳入2007年1月至2009年1月期间201例年龄>60岁（年龄：68.0±7.5岁；男∶女 = 1.8∶1）的新发癫痫发作老年患者。分析头颅CT扫描（n = 201）和磁共振成像（MR成像，n = 43）的表现。
癫痫发作类型包括：单纯部分性发作（42%）、全身强直 - 阵挛发作（30.3%）和复杂部分性发作（27.4%）。癫痫综合征类型为急性症状性（42.3%）、既往症状性（18.4%）、隐源性（37.8%）和特发性（1.5%）。85%的患者通过单药治疗控制了癫痫发作。CT扫描（n = 201）显示脑萎缩（139例），轻度（79例）、中度（43例）和重度（18例）；局灶性病变（98例），梗死（45例）、出血（18例）、肉芽肿（16例）、肿瘤（15例）和胶质增生（4例），以及半球萎缩（1例）、白质改变（75例）和弥漫性水肿（21例）。MR成像（n = 43）显示不同程度的脑萎缩（31例）；白质改变（20例）；局灶性脑病变（24例）；梗死（7例）；颅内出血（6例）；肉芽肿（5例）；肿瘤（6例）；胶质增生（1例）；半球萎缩（1例）；以及显著的血管周围间隙（7例）和未确定的脑内病变（UBOs，12例）。神经影像学显示有局灶性病变的患者更常出现部分性发作、症状性癫痫、既往卒中、局灶性神经功能缺损、无弥漫性萎缩、局灶性脑电图减慢、脑脊液异常、随访时癫痫复发（P < 0.05）。
新发癫痫发作老年患者的脑影像学表现揭示了潜在的症状性本质，从而有助于明确病因并据此决定具体治疗方案。
