Shah Snehal, Nagarajan Lakshmi, Palumbo Linda, Walsh Peter, Silberstein Jonathan, Cannell Patricia, Ghosh Soumya
Department of Neurology, Children's Neuroscience Service, Princess Margaret Hospital for Children, Perth, Western Australia, Australia.
J Paediatr Child Health. 2019 Jul;55(7):789-794. doi: 10.1111/jpc.14290. Epub 2018 Nov 8.
A new-onset seizure clinic (NOSC) was established at our hospital in 2011, with the aim to provide accurate diagnosis and appropriate management to children with new-onset seizures or seizure mimics.
We report on the data analysis of the first 200 children seen in NOSC. A paediatric neurologist or paediatric/neurology trainee under supervision of a neurologist reviewed all the children. A detailed history and clinical examination were undertaken. Electroencephalogram (EEGs) were undertaken prior to clinic review in most emergency departments. Children were classified as 'epilepsy positive' (EP+) or 'epilepsy negative' (EP-) after the first consultation.
Of 200 patients, 109 were classified as EP+: generalised epilepsy in 57 of 109, focal in 36, childhood seizure susceptibility syndrome in 26 and epileptic encephalopathy in 5. EEG was available in 192: in 117, it was abnormal - 23 with background abnormalities and 109 with epileptiform activity. Of the 109 patients, 80 were commenced on anti-epileptic drugs (AEDs): 12 were able to come off medication after seizure-free period, 61 were controlled on AEDs and 7 were refractory. Children were followed up for 12-48 months. None of the children had diagnosis revised on follow-up.
This is the first Australian study to report on a large cohort of children from a NOSC. An EEG and a paediatric neurologist assessment is a good combination to enable diagnostic accuracy: In the first 200 patients seen, there were no revisions of the initial diagnosis on follow-up.
2011年我院设立了新发癫痫门诊（NOSC），旨在为新发癫痫或疑似癫痫的儿童提供准确诊断和恰当治疗。
我们报告了在NOSC就诊的首批200名儿童的数据分析情况。由儿科神经科医生或在神经科医生监督下的儿科/神经科实习医生对所有儿童进行了检查。进行了详细的病史询问和临床检查。大多数急诊科在门诊检查前进行了脑电图（EEG）检查。初诊后，儿童被分为“癫痫阳性”（EP+）或“癫痫阴性”（EP-）。
200例患者中，109例被分类为EP+：109例中有57例为全身性癫痫，36例为局灶性癫痫，26例为儿童癫痫易感性综合征，5例为癫痫性脑病。192例有EEG结果：其中117例异常——23例有背景异常，109例有癫痫样活动。109例患者中，80例开始使用抗癫痫药物（AEDs）：12例在无癫痫发作期后停药，61例使用AEDs后得到控制，7例难治。对儿童进行了12至48个月的随访。随访期间没有儿童的诊断被修订。
这是澳大利亚第一项关于来自新发癫痫门诊的大量儿童队列的研究。脑电图和儿科神经科医生评估是提高诊断准确性的良好组合：在首批就诊的200例患者中，随访期间初始诊断没有修订。
