Mikami Takeshi, Ochi Satoko, Houkin Kiyohiro, Akiyama Yukinori, Wanibuchi Masahiko, Mikuni Nobuhiro
Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan.
Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
J Stroke Cerebrovasc Dis. 2015 Jan;24(1):17-23. doi: 10.1016/j.jstrokecerebrovasdis.2014.07.050. Epub 2014 Oct 16.
Epilepsy cannot always be recognized in patients with moyamoya disease. In this report, the clinical features of patients with epilepsy were evaluated for assessing the predictive factors of epilepsy in moyamoya disease.
A total of 64 consecutive patients with moyamoya disease were included in this study. During their follow-up periods, 7 patients were diagnosed with epilepsy. Then, the patients with epilepsy were compared with the patients without epilepsy regarding their clinical features.
Analysis of patient background characteristics revealed a significantly higher incidence of epilepsy in patients with high modified Rankin Scale (mRS) scores, high cerebrovascular attack scores, onset age of 3 years or less, early seizures, cortical involvement, stroke subtype, and diffuse brain atrophy. A logistic analysis of epilepsy data revealed significant differences between the 2 groups in mRS score, cerebrovascular attack score, onset age 3 years or less, early seizure, cortical involvement, stroke subtype, and diffuse brain atrophy. Of these, significant differences were noted in 3 items (mRS score, early seizure, and diffuse brain atrophy) on multivariate analysis. These 3 items were selected as the basis of our new moyamoya disease epilepsy risk scale (MDERS), which we then evaluated. The cutoff value estimated by the receiver operating characteristic curve was set at 1 (sensitivity, .857; specificity, .825) or 2 (sensitivity, .571; specificity, 1.000).
Epilepsy in moyamoya disease is associated with clinical factors and is not an independent category. For prediction of epilepsy in moyamoya disease, MDERS is a simple and convenient assessment scale.
烟雾病患者并非总能被诊断出患有癫痫。在本报告中，对癫痫患者的临床特征进行了评估，以确定烟雾病中癫痫的预测因素。
本研究共纳入64例连续的烟雾病患者。在随访期间，7例患者被诊断为癫痫。然后，将癫痫患者与无癫痫患者的临床特征进行比较。
对患者背景特征的分析显示，改良Rankin量表（mRS）评分高、脑血管发作评分高、发病年龄3岁及以下、早期癫痫发作、皮质受累、卒中亚型和弥漫性脑萎缩的患者癫痫发病率显著更高。对癫痫数据进行逻辑分析发现，两组在mRS评分、脑血管发作评分、发病年龄3岁及以下、早期癫痫发作、皮质受累、卒中亚型和弥漫性脑萎缩方面存在显著差异。其中，多因素分析显示3项指标（mRS评分、早期癫痫发作和弥漫性脑萎缩）存在显著差异。这3项指标被选为我们新的烟雾病癫痫风险量表（MDERS）的基础，随后我们对其进行了评估。通过受试者工作特征曲线估计的截断值设定为1（敏感性，0.857；特异性，0.825）或2（敏感性，0.571；特异性，1.000）。
烟雾病中的癫痫与临床因素相关，并非一个独立的类别。对于预测烟雾病中的癫痫，MDERS是一种简单方便的评估量表。
