Crocker Candice E, Pohlmann-Eden Bernhard, Schmidt Matthias H
Department of Diagnostic Radiology, Dalhousie University, Room 3388, Halifax Infirmary, 1796 Summer Street, Halifax, Nova Scotia B3H 3A7, Canada; Nova Scotia Early Psychosis Program, Department of Psychiatry, Dalhousie University, Rm 3030, Abbie J Lane Building, 5909 Veterans' Memorial Lane, Halifax, Nova Scotia B3H 2E2, Canada.
Division of Neurology, Department of Medicine, Dalhousie University, Room No 3838, Halifax Infirmary, 1796 Summer Street, Halifax, Nova Scotia B3H 3A7, Canada.
Seizure. 2017 Jul;49:74-78. doi: 10.1016/j.seizure.2016.05.015. Epub 2016 Jun 1.
The primary goal of neuroimaging in a first, unprovoked seizure is to identify a lesion that can explain the seizure. Secondarily, neuroimaging may be used to predict seizure recurrence and assist with the diagnosis of epilepsy. However, the events leading from a first seizure to epilepsy, with or without an identifiable epileptogenic lesion, are not well understood, and it is not always clear which lesions are epileptogenic as opposed to incidental. Much neuroimaging research to date has focused on findings in chronic epilepsy, rather than first seizure. Dedicated epilepsy imaging with high quality MRI protocols maximizes the likelihood of a diagnosis. However, a significant proportion of patients are MRI-negative, prompting researchers in the field to continue the search for better imaging strategies. Here we describe the role of neuroimaging in the assessment of a first seizure, the current state of the art and possible future directions.
对于首次无诱因发作，神经影像学检查的主要目标是识别可解释该发作的病变。其次，神经影像学可用于预测发作复发并辅助癫痫的诊断。然而，从首次发作发展至癫痫（无论有无可识别的致痫性病变）的过程尚未完全明确，并且并不总是清楚哪些病变是致痫性的，哪些是偶然发现的。迄今为止，许多神经影像学研究都集中在慢性癫痫的发现上，而非首次发作。采用高质量MRI方案进行专门的癫痫成像可最大程度提高诊断的可能性。然而，相当一部分患者的MRI检查结果为阴性，促使该领域的研究人员继续寻找更好的成像策略。在此，我们描述神经影像学在首次发作评估中的作用、当前的技术水平以及可能的未来发展方向。
