儿童有症状和疑似有症状的局灶性癫痫：一项观察性、前瞻性多中心研究。

Symptomatic and presumed symptomatic focal epilepsies in childhood: An observational, prospective multicentre study.

作者信息

Vecchi Marilena, Barba Carmen, De Carlo Debora, Stivala Micol, Guerrini Renzo, Albamonte Emilio, Ranalli Domiziana, Battaglia Domenica, Lunardi Giada, Boniver Clementina, Piccolo Benedetta, Pisani Francesco, Cantalupo Gaetano, Nieddu Giuliana, Casellato Susanna, Cappanera Silvia, Cesaroni Elisabetta, Zamponi Nelia, Serino Domenico, Fusco Lucia, Iodice Alessandro, Palestra Filippo, Giordano Lucio, Freri Elena, De Giorgi Ilaria, Ragona Francesca, Granata Tiziana, Fiocchi Isabella, Bova Stefania Maria, Mastrangelo Massimo, Verrotti Alberto, Matricardi Sara, Fontana Elena, Caputo Davide, Darra Francesca, Dalla Bernardina Bernardo, Beccaria Francesca, Capovilla Giuseppe, Baglietto Maria Pia, Gagliardi Alessandra, Vignoli Aglaia, Canevini Maria Paola, Perissinotto Egle, Francione Stefano

机构信息

Department of Woman and Child Health, University of Padua, Padua, Italy.

Pediatric Neurology Unit and Laboratories, Children's Hospital Meyer-University of Florence, Florence, Italy.

出版信息

Epilepsia. 2016 Nov;57(11):1808-1816. doi: 10.1111/epi.13574. Epub 2016 Oct 20.

DOI:10.1111/epi.13574

PMID:27762437

Abstract

OBJECTIVE

To describe the clinical, neuropsychological, and psychopathologic features of a cohort of children with a new diagnosis of symptomatic or presumed symptomatic focal epilepsy at time of recruitment and through the first month. The selected population will be followed for 2-5 years after enrollment to investigate the epilepsy course and identify early predictors of drug resistance.

METHODS

In this observational, multicenter, nationwide study, children (age 1 month-12.9 years) with a new diagnosis of symptomatic or presumed symptomatic focal epilepsy were consecutively enrolled in 15 Italian tertiary childhood epilepsy centers. Inclusion criteria were as follows: (1) diagnosis of symptomatic focal epilepsy due to acquired and developmental etiologies, and presumed symptomatic focal epilepsy; (2) age at diagnosis older than 1 month and <13 years; and (3) written informed consent. Children were subdivided into three groups: ≤3 years, >3 to 6 years, and >6 years. Clinical, electroencephalography (EEG), neuroimaging, and neuropsychological variables were identified for statistical analyses.

RESULTS

Two hundred fifty-nine children were enrolled (116 female and 143 male). Median age: 4.4 years (range 1 month-12.9 years); 46.0% (n = 119) of children were younger than 3 years, 24% (61) from 3 to 6 years of age, and 30% (79) older than 6 years. Neurologic examination findings were normal in 71.8%. Brain magnetic resonance imaging (MRI) was abnormal in 59.9%. Children age ≤3 years experienced the highest seizure frequency in the first month after recruitment (p < 0.0001). Monotherapy in the first month was used in 67.2%. Cognitive tests at baseline revealed abnormal scores in 30%; behavioral problems were present in 21%. At multivariate analysis, higher chances to exhibit more than five seizures in the first month after epilepsy onset was confirmed for younger children and those with temporal lobe epilepsy.

SIGNIFICANCE

In this prospective cohort study, an extensive characterization of epilepsy onset in children with symptomatic or presumed symptomatic focal epilepsies is reported in relation to the age group and the localization of the epileptogenic zone.

摘要

目的

描述一组在招募时新诊断为症状性或疑似症状性局灶性癫痫且在第一个月内的儿童的临床、神经心理学和精神病理学特征。入选人群在入组后将随访2至5年，以研究癫痫病程并确定耐药性的早期预测因素。

方法

在这项观察性、多中心、全国性研究中，新诊断为症状性或疑似症状性局灶性癫痫的儿童（年龄1个月至12.9岁）连续入选15家意大利三级儿童癫痫中心。纳入标准如下：（1）因获得性和发育性病因诊断为症状性局灶性癫痫以及疑似症状性局灶性癫痫；（2）诊断时年龄大于1个月且小于13岁；（3）书面知情同意。儿童被分为三组：≤3岁、>3至6岁和>6岁。确定临床、脑电图（EEG）、神经影像学和神经心理学变量用于统计分析。

结果

共招募259名儿童（116名女性和143名男性）。中位年龄：4.4岁（范围1个月至12.9岁）；46.0%（n = 119）的儿童年龄小于3岁，24%（61名）年龄在3至6岁之间），30%（79名）年龄大于6岁。71.8%的儿童神经系统检查结果正常。脑磁共振成像（MRI）异常的比例为59.9%。年龄≤3岁的儿童在招募后的第一个月癫痫发作频率最高（p < <0.0001）。第一个月采用单药治疗的比例为67.2%）。基线认知测试显示30%的儿童得分异常；21%的儿童存在行为问题。多变量分析证实，年龄较小的儿童和颞叶癫痫患儿在癫痫发作后的第一个月出现五次以上癫痫发作的可能性更高。