Arabi Maher, Dirani Maya, Hourani Roula, Nasreddine Wassim, Wazne Jaafar, Atweh Samir, Samara Heba, Shatila Abdel Rahman, Beydoun Ahmad
Ibn Sina Hospital, Kuwait City, Kuwait.
American University of Beirut Medical Center, Beirut, Lebanon.
Front Neurol. 2018 Nov 30;9:995. doi: 10.3389/fneur.2018.00995. eCollection 2018.
To evaluate prospectively the frequency of epileptogenic lesions in a consecutive cohort of elderly patients presenting with new onset unprovoked seizures, and who underwent a complete evaluation including dedicated epilepsy protocol MRI. We included all consecutive patients 60 years or older who participated in a prospective study on new onset epilepsy. The work-up included the acquisition of a dedicated epilepsy protocol MRI and a 3 h video/EEG recording. We evaluated the frequency and types of epileptogenic lesions in the whole cohort and stratified those variables by age, gender, types and number of seizures at presentation. We also correlated the EEG findings with the clinical characteristics and neuroimaging results. Of the 101 patients enrolled in the study and who underwent an epilepsy protocol MRI, an epileptogenic lesion was identified in 67% of cases. The most common etiologies were vascular events, followed by tumoral causes and traumatic brain injuries. Epileptogenic lesions were more likely to be identified in patients who presented with only focal aware and impaired awareness seizures. In addition, patients with tumoral epilepsy were significantly more likely to only experience those seizure types compared to patients with other pathological substrates. Interictal/ictal discharges were detected in the EEG of 21% of patients. Epileptiform discharges were significantly more frequent in patients with an epileptogenic lesion on brain MRI, especially in those with a brain tumor. Our results stress the importance of obtaining a dedicated epilepsy protocol MRI in elderly patients with new onset seizures. An epileptogenic lesion will be identified in approximately two thirds of patients with important implications regarding initiation of treatment. In addition, the data underscore the value of distinguishing the types of seizures experienced at presentation as this will apprise the treating physician on the likelihood of identifying an epileptogenic lesion and on the probable etiologies.
前瞻性评估一组连续的新发无诱因癫痫老年患者中致痫性病变的发生率，这些患者均接受了包括专门的癫痫方案MRI在内的全面评估。我们纳入了所有60岁及以上参与新发癫痫前瞻性研究的连续患者。检查包括获取专门的癫痫方案MRI和3小时的视频/脑电图记录。我们评估了整个队列中致痫性病变的频率和类型，并按年龄、性别、发作时的癫痫类型和发作次数对这些变量进行分层。我们还将脑电图结果与临床特征和神经影像学结果进行了关联。在纳入研究并接受癫痫方案MRI检查的101例患者中，67%的病例发现了致痫性病变。最常见的病因是血管事件，其次是肿瘤性病因和创伤性脑损伤。仅出现局灶性意识清楚和意识障碍发作的患者更有可能发现致痫性病变。此外，与其他病理基础的患者相比，肿瘤性癫痫患者更有可能仅经历这些发作类型。21%的患者脑电图检测到发作间期/发作期放电。脑MRI上有致痫性病变的患者癫痫样放电明显更频繁，尤其是有脑肿瘤的患者。我们的结果强调了在新发癫痫的老年患者中获取专门的癫痫方案MRI的重要性。大约三分之二的患者将发现致痫性病变，这对治疗的启动具有重要意义。此外，数据强调了区分发作时经历的癫痫类型的价值，因为这将告知治疗医生发现致痫性病变的可能性以及可能的病因。
