Unidad de Neuropediatría, Hospital Miguel Servet, Zaragoza, España.
Unidad de Neuropediatría, Hospital Miguel Servet, Zaragoza, España.
Neurologia. 2017 Sep;32(7):455-462. doi: 10.1016/j.nrl.2016.02.010. Epub 2016 Apr 16.
We conducted a descriptive study of symptomatic epilepsy by age at onset in a cohort of patients who were followed up at a neuropaediatric department of a reference hospital over a 3-year period PATIENTS AND METHODS: We included all children with epilepsy who were followed up from January 1, 2008 to December 31, 2010 RESULTS: Of the 4595 children seen during the study period, 605 (13.17%) were diagnosed with epilepsy; 277 (45.79%) of these had symptomatic epilepsy. Symptomatic epilepsy accounted for 67.72% and 61.39% of all epilepsies starting before one year of age, or between the ages of one and 3, respectively. The aetiologies of symptomatic epilepsy in our sample were: prenatal encephalopathies (24.46% of all epileptic patients), perinatal encephalopathies (9.26%), post-natal encephalopathies (3.14%), metabolic and degenerative encephalopathies (1.98%), mesial temporal sclerosis (1.32%), neurocutaneous syndromes (2.64%), vascular malformations (0.17%), cavernomas (0.17%), and intracranial tumours (2.48%). In some aetiologies, seizures begin before the age of one; these include Down syndrome, genetic lissencephaly, congenital cytomegalovirus infection, hypoxic-ischaemic encephalopathy, metabolic encephalopathies, and tuberous sclerosis.
The lack of a universally accepted classification of epileptic syndromes makes it difficult to compare series from different studies. We suggest that all epilepsies are symptomatic because they have a cause, whether genetic or acquired. The age of onset may point to specific aetiologies. Classifying epilepsy by aetiology might be a useful approach. We could establish 2 groups: a large group including epileptic syndromes with known aetiologies or associated with genetic syndromes which are very likely to cause epilepsy, and another group including epileptic syndromes with no known cause. Thanks to the advances in neuroimaging and genetics, the latter group is expected to become increasingly smaller.
我们对一家参考医院神经儿科就诊的患者中按发病年龄划分的症状性癫痫患者进行了描述性研究。
我们纳入了 2008 年 1 月 1 日至 2010 年 12 月 31 日期间接受随访的所有癫痫患儿。
在所研究期间，4595 名儿童中有 605 名（13.17%）被诊断为癫痫；其中 277 名（45.79%）患有症状性癫痫。症状性癫痫分别占所有 1 岁前和 1-3 岁起病癫痫的 67.72%和 61.39%。我们样本中症状性癫痫的病因是：产前脑病（所有癫痫患者的 24.46%）、围产期脑病（9.26%）、产后脑病（3.14%）、代谢性和退行性脑病（1.98%）、内侧颞叶硬化症（1.32%）、神经皮肤综合征（2.64%）、血管畸形（0.17%）、海绵状血管瘤（0.17%）和颅内肿瘤（2.48%）。在一些病因中，癫痫发作发生在 1 岁之前，包括唐氏综合征、遗传无脑回畸形、先天性巨细胞病毒感染、缺氧缺血性脑病、代谢性脑病和结节性硬化症。
由于缺乏普遍接受的癫痫综合征分类，因此难以比较来自不同研究的系列。我们建议所有癫痫都是症状性的，因为它们有病因，无论是遗传的还是获得性的。发病年龄可能指向特定的病因。根据病因对癫痫进行分类可能是一种有用的方法。我们可以将其分为两组：一组包括已知病因或与很可能引起癫痫的遗传综合征相关的癫痫综合征，另一组包括病因不明的癫痫综合征。得益于神经影像学和遗传学的进步，后者的比例预计会越来越小。
