儿童癫痫的发作、综合征及病因：基于人群队列研究中使用的国际抗癫痫联盟1981年、1989年及2017年分类法

Seizures, syndromes, and etiologies in childhood epilepsy: The International League Against Epilepsy 1981, 1989, and 2017 classifications used in a population-based cohort.

作者信息

Aaberg Kari Modalsli, Surén Pål, Søraas Camilla Lund, Bakken Inger Johanne, Lossius Morten I, Stoltenberg Camilla, Chin Richard

机构信息

National Center for Epilepsy, Oslo University Hospital, University of Oslo, Oslo, Norway.

Norwegian Institute of Public Health, Oslo, Norway.

出版信息

Epilepsia. 2017 Nov;58(11):1880-1891. doi: 10.1111/epi.13913. Epub 2017 Sep 26.

DOI:10.1111/epi.13913

PMID:28949013

Abstract

OBJECTIVE

The study provides updated information about the distribution of seizures, epilepsies, and etiologies of epilepsy in the general child population, and compares the old and new classification systems from the International League Against Epilepsy (ILAE).

METHODS

The study platform was the Norwegian Mother and Child Cohort Study. Cases of epilepsy were identified through registry linkages and sequential parental questionnaires. Epilepsy diagnoses were validated using a standardized protocol, and seizures, epilepsies, and etiologies were classified according to the old (ILAE 1981/1989) and new (ILAE 2017) classifications. Information was collected through medical record reviews and/or parental telephone interviews.

RESULTS

The study population included 112,744 children aged 3-13 years at the end of follow-up on December 31, 2012. Of these, there were 606 children with epilepsy (CWE). Distribution of seizure types varied by age of onset. Multiple seizure types were common with early onset. Focal epilepsies were the most common, occurring in 317 per 100,000 children in the study population and in 59% of CWE. Generalized epilepsies were found in 190 per 100,000 (35% of CWE). CWE with onset during the first 2 years of life had an even distribution of focal and generalized epilepsies, whereas focal epilepsies became dominant at later ages of onset. A definite cause of epilepsy had been demonstrated in 33% of CWE. The ILAE 1989 classification allowed for a broad syndrome category in 93% of CWE and a defined epileptic syndrome in 37%. With the ILAE 2017 classification, 41% of CWE had a defined epileptic syndrome and 63% had either a defined syndrome or structural-metabolic etiology.

SIGNIFICANCE

The distribution of seizures and epilepsies is strongly dependent on age of onset. Despite diagnostic advances, the causes of epilepsy are still unknown in two-thirds of CWE. The ILAE 2017 classifications allow for a higher precision of diagnoses, but at the expense of leaving more epilepsies classifiable only at the mode of onset level.

摘要

目的

本研究提供了有关普通儿童群体中癫痫发作、癫痫类型及癫痫病因分布的最新信息，并比较了国际抗癫痫联盟（ILAE）的新旧分类系统。

方法

研究平台为挪威母婴队列研究。通过登记链接和连续的家长问卷调查来确定癫痫病例。使用标准化方案对癫痫诊断进行验证，并根据旧的（ILAE 1981/1989）和新的（ILAE 2017）分类对癫痫发作、癫痫类型及病因进行分类。通过病历审查和/或家长电话访谈收集信息。

结果

研究人群包括在2012年12月31日随访结束时年龄为3至13岁的112,744名儿童。其中，有606名儿童患有癫痫（CWE）。癫痫发作类型的分布因发病年龄而异。多种发作类型在早发型中较为常见。局灶性癫痫最为常见，在研究人群中每10万名儿童中有317例发生，在CWE中占59%。全身性癫痫在每10万名儿童中有190例（占CWE的35%）。在生命的前2年发病的CWE中，局灶性癫痫和全身性癫痫分布均匀，而局灶性癫痫在发病年龄较大时占主导地位。33%的CWE已证实有明确的癫痫病因。ILAE 1989分类在93%的CWE中允许使用宽泛的综合征类别，在37%的CWE中允许使用明确的癫痫综合征。采用ILAE 2017分类时，41%的CWE有明确的癫痫综合征，63%有明确的综合征或结构-代谢病因。