成人首次和复发癫痫发作后的诊断决策。

Diagnostic decision-making after a first and recurrent seizure in adults.

机构信息

Department of Clinical Neurophysiology at MIRA Institute for Biomedical Engineering and Technical Medicine, University of Twente, Enschede, The Netherlands.

出版信息

Seizure. 2013 Sep;22(7):507-11. doi: 10.1016/j.seizure.2013.03.012. Epub 2013 Apr 23.

DOI:10.1016/j.seizure.2013.03.012

PMID:23623152

Abstract

PURPOSE

The role of EEG after a first seizure has been debated. Epileptiform EEG activity is a good predictor of seizure recurrence, but is reported in only 8-50% of first-seizure adult patients. Even if the EEG is abnormal, the opinions about treatment after a first seizure differ. The role of EEG in treatment decisions after remission or recurrence is also unclear. This study aims to identify neurologists' diagnostic strategies compared to guidelines about the use of EEG (i) after a first unprovoked generalized seizure in adults, (ii) after a recurrent seizure and (iii) in treatment decisions after recurrence or remission.

METHOD

All members of the Dutch Neurological Society were invited to participate in our on-line survey about the use of EEG after a first seizure, after recurrent seizures and in treatment decisions. Ten percent (N=110) of invitees participated, including mainly clinical neurophysiologists, general neurologists and neurologists-in-training.

RESULTS

Ninety-five percent of the respondents would request a routine EEG after a first seizure. After normal MRI and EEG findings, 4% would record a second routine EEG, 48% a sleep-deprived EEG and 45% would not repeat the EEG. If a recurrent seizure occurs within six, or after 12 or 24 months, 87%, 67% and 44% would respectively conclude that the patient has epilepsy, while 57%, 65% and 72% would request an EEG. When a patient experiences a recurrence while being treated with anti-epileptic drugs, 11% of the respondents would request an EEG. Twenty-five percent would request an EEG before stopping medication after two years of remission.

CONCLUSION

The variability in neurologists' reported strategies about the use of EEG in the diagnosis of seizures is remarkably large. Consequences for the individual patient may be significant, including treatment decisions and driving restrictions. The availability and use of more sensitive diagnostic methods may be necessary to enhance agreement between neurologists.

摘要

目的

首次发作后脑电图（EEG）的作用一直存在争议。癫痫样 EEG 活动是癫痫复发的良好预测指标，但仅在 8-50%的首次发作成年患者中报告。即使 EEG 异常，关于首次发作后治疗的意见也存在分歧。EEG 在缓解或复发后的治疗决策中的作用也不清楚。本研究旨在确定与指南相比，神经科医生在诊断策略方面的差异，这些差异涉及（i）成人首次无诱因全面性发作后，（ii）复发性发作后，以及（iii）在缓解或复发后的治疗决策中。

方法

邀请荷兰神经病学学会的所有成员参加我们关于首次发作后、复发性发作后以及在缓解或复发后的治疗决策中使用 EEG 的在线调查。邀请的 10%（N=110）参与者包括主要是临床神经生理学家、普通神经病学家和神经科住院医师。

结果

95%的受访者会在首次发作后要求进行常规 EEG。在正常的 MRI 和 EEG 结果后，4%会记录第二次常规 EEG，48%会进行睡眠剥夺 EEG，而 45%则不会重复 EEG。如果在 6 个月内、12 个月后或 24 个月后再次发作，87%、67%和 44%将分别得出患者患有癫痫的结论，而 57%、65%和 72%将要求进行 EEG。如果患者在接受抗癫痫药物治疗时复发，11%的受访者会要求进行 EEG。25%的人会在缓解两年后停止药物治疗前要求进行 EEG。