Delaney S, Fitzsimons M, White M, Power K, O' Donoghue S, Kilbride R, Widdess-Walsh P, El Naggar H, Delanty N
Epilepsy Programme, Beaumont Hospital, Dublin, Ireland.
SFI FutureNeuro Research Centre, Dublin, Ireland.
Seizure. 2020 Oct;81:332-337. doi: 10.1016/j.seizure.2020.08.005. Epub 2020 Aug 22.
The aim of this study was to review the causes of the epilepsies in our institution, an adult tertiary referral center for neurology and neurosurgery in Dublin, Ireland. Data was obtained from a bespoke epilepsy electronic patient record (EPR).
Predetermined search parameters of well-established broad categories of epilepsy aetiology were used to identify patients with a diagnosis of epilepsy attending Beaumont Hospital, Dublin. There were 3216 patients that met the inclusion criteria for this study. We included living patients with epilepsy attending our institution. We then excluded patients with a diagnosis of pure non-epileptic attack disorder and patients found to have idiopathic generalised epilepsy (IGE) (n = 382) from our final cohort. We excluded IGE due to the complex polygenic basis underlying this patient group.
An aetiology was identified in 54.3 % (n = 1747) of the total number of patients studied. Of the symptomatic epilepsies, 41.08 % (n = 1321) were acquired and 13.3 % (n = 426) were predominantly of genetic or developmental aetiology. The most common causes of the acquired epilepsies were hippocampal sclerosis (n = 380; 28.75 %), cerebral tumor (n = 279; 21.06 %), traumatic brain injury (n = 248; 18.77 %), stroke and cerebrovascular disease (n = 151; 11.43 %) and perinatal causes (n = 138; 10.45 %). The leading causes in the genetic / developmental category included cavernous haemangiomas (n = 62, 22.22 %), arteriovenous malformations (n = 59; 21.15 %) and cortical dysplasia (n = 55; 19.71 %). The aetiology of a patient's epilepsy was undetermined in 45.68 % (n = 1469) of individuals.
This study emphasizes the clinical utility of the ILAE's 2017 revised classification of the epilepsies and highlights the evolving dynamic nature of attributing causality in epilepsy. This is the largest single centre analysis of the aetiology of the epilepsies described in the literature. It is also the first large scale study examining aetiology utilising a bespoke electronic patient record in epilepsy.
本研究旨在回顾我们机构（爱尔兰都柏林一家成人神经病学和神经外科三级转诊中心）癫痫的病因。数据来自定制的癫痫电子病历（EPR）。
使用既定的癫痫病因学广泛类别中的预定搜索参数，来识别在都柏林博蒙特医院就诊且诊断为癫痫的患者。有3216名患者符合本研究的纳入标准。我们纳入了在我们机构就诊的癫痫患者。然后，我们从最终队列中排除了诊断为单纯非癫痫性发作障碍的患者以及被发现患有特发性全身性癫痫（IGE）的患者（n = 382）。由于该患者群体存在复杂的多基因基础，我们排除了IGE。
在所研究的患者总数中，54.3%（n = 1747）确定了病因。在症状性癫痫中，41.08%（n = 1321）是后天获得性的，13.3%（n = 426）主要是遗传或发育性病因。后天性癫痫最常见的病因是海马硬化（n = 380；28.75%）、脑肿瘤（n = 279；21.06%）、创伤性脑损伤（n = 248；18.77%）、中风和脑血管疾病（n = 151；11.43%）以及围产期病因（n = 138；10.45%）。遗传/发育类别中的主要病因包括海绵状血管瘤（n = 62，22.22%）、动静脉畸形（n = 59；21.15%）和皮质发育异常（n = 55；19.71%）。45.68%（n = 1469）的患者癫痫病因未确定。
本研究强调了国际抗癫痫联盟（ILAE）2017年修订的癫痫分类的临床实用性，并突出了癫痫病因归因中不断演变的动态性质。这是文献中描述的癫痫病因的最大规模单中心分析。这也是第一项利用定制电子病历研究癫痫病因的大规模研究。
