De Stefano Pia, Ménétré Eric, Stancu Patrick, Mégevand Pierre, Vargas Maria Isabelle, Kleinschmidt Andreas, Vulliémoz Serge, Wiest Roland, Beniczky Sandor, Picard Fabienne, Seeck Margitta
EEG & Epilepsy Unit, Department of Clinical Neurosciences, University Hospitals of Geneva, Geneva, Switzerland.
Neuro-Intensive Care Unit, Department of Intensive Care, University Hospitals of Geneva, Geneva, Switzerland.
Epilepsia. 2023 Dec;64(12):3246-3256. doi: 10.1111/epi.17771. Epub 2023 Oct 7.
This study was undertaken to establish whether advanced workup including long-term electroencephalography (LT-EEG) and brain magnetic resonance imaging (MRI) provides an additional yield for the diagnosis of new onset epilepsy (NOE) in patients presenting with a first seizure event (FSE).
In this population-based study, all adult (≥16 years) patients presenting with FSE in the emergency department (ED) between March 1, 2010 and March 1, 2017 were assessed. Patients with obvious nonepileptic or acute symptomatic seizures were excluded. Routine EEG, LT-EEG, brain computed tomography (CT), and brain MRI were performed as part of the initial workup. These examinations' sensitivity and specificity were calculated on the basis of the final diagnosis after 2 years, along with the added value of advanced workup (MRI and LT-EEG) over routine workup (routine EEG and CT).
Of the 1010 patients presenting with FSE in the ED, a definite diagnosis of NOE was obtained for 501 patients (49.6%). Sensitivity of LT-EEG was higher than that of routine EEG (54.39% vs. 25.5%, p < .001). Similarly, sensitivity of MRI was higher than that of CT (67.98% vs. 54.72%, p = .009). Brain MRI showed epileptogenic lesions in an additional 32% compared to brain CT. If only MRI and LT-EEG were considered, five would have been incorrectly diagnosed as nonepileptic (5/100, 5%) compared to patients with routine EEG and MRI (25/100, 25%, p = .0001). In patients with all four examinations, advanced workup provided an overall additional yield of 50% compared to routine workup.
Our results demonstrate the remarkable added value of the advanced workup launched already in the ED for the diagnosis of NOE versus nonepileptic causes of seizure mimickers. Our findings suggest the benefit of first-seizure tracks or even units with overnight EEG, similar to stroke units, activated upon admission in the ED.
本研究旨在确定包括长期脑电图（LT - EEG）和脑磁共振成像（MRI）在内的高级检查对于首次发作事件（FSE）患者新发癫痫（NOE）的诊断是否能提供额外的诊断价值。
在这项基于人群的研究中，对2010年3月1日至2017年3月1日期间在急诊科（ED）出现FSE的所有成年（≥16岁）患者进行了评估。排除有明显非癫痫性或急性症状性发作的患者。作为初始检查的一部分，进行了常规脑电图、LT - EEG、脑计算机断层扫描（CT）和脑MRI检查。根据2年后的最终诊断计算这些检查的敏感性和特异性，以及高级检查（MRI和LT - EEG）相对于常规检查（常规脑电图和CT）的附加值。
在急诊科出现FSE的1010例患者中，501例（49.6%）被明确诊断为NOE。LT - EEG的敏感性高于常规脑电图（54.39%对25.5%，p <.001）。同样，MRI的敏感性高于CT（67.98%对54.72%，p =.009）。与脑CT相比，脑MRI显示出另外32%的致痫性病变。如果仅考虑MRI和LT - EEG，与进行常规脑电图和MRI的患者相比，有5例（5/100，5%）会被错误诊断为非癫痫性发作（25/100，25%，p =.0001）。在进行了所有四项检查的患者中，与常规检查相比，高级检查的总体额外诊断价值为50%。
我们的结果表明，在急诊科开展的高级检查对于诊断NOE与癫痫样发作的非癫痫性病因相比具有显著的附加值。我们的研究结果表明，类似于卒中单元，在急诊科入院时启动配备夜间脑电图的首次发作追踪甚至单元可能有益。
