Holtås S, Rosén I
Avdelningen för diagnostisk radiologi, Universitetssjukhuset i Lund.
Lakartidningen. 1997 Jun 4;94(23):2194-200.
Electroencephalography (EEG) and neuroradiology are both indispensible techniques in cases of suspected epileptic seizure, when the aim of investigation is to determine whether the seizure was of epileptic nature, and if so whether it was the result of specific provocative factors or an expression of epileptic disease. In the latter case, the epileptic condition should be classified and its aetiology determined, if possible. Routine or sleep EEG providing interictal epileptiform discharges is a useful aid to differential diagnosis. To obtain EEG recordings during actual seizures, long-term recordings, using either ambulatory equipment or an EEG-video procedure, are usually used. The combination of EEG and video recording, using surface or surgically implanted electrodes, is a procedure of major importance in the evaluation of patients refractory to medical treatment and possible candidates for epilepsy surgery. In cases of epilepsy suspected to be caused by tumour or cerebrovascular disease, neurological investigation does not differ from that routinely used in such conditions. MRI (magnetic resonance imaging) techniques have become important aids in the preoperative work-up in cases of chronic therapy-resistant partial epilepsy. MRI has also simplified the identification of minor morphological abnormalities causing partial epilepsy, and is the method of choice in such cases. The sensitivity of MRI is improved by its combination with volumetric measurements and spectroscopy. The use of functional neuroimaging with SPECT (single photon emission computed tomography) and PET (positron emission tomography) during seizures provides further information. A promising new development is the co-registration of MRI and functional imaging (dipolar reconstruction of EEG spikes and seizure patterns, SPECT, PET). MRI is a cornerstone of the preoperative work-up, but diagnosis and the choice of therapeutic approach is always based on the clinical picture, EEG, and functional and morphological imaging.
脑电图（EEG）和神经放射学在疑似癫痫发作的病例中都是不可或缺的技术。当调查目的是确定发作是否具有癫痫性质，如果是，是否是特定诱发因素的结果或癫痫疾病的表现时，这两种技术就显得尤为重要。在后一种情况下，应尽可能对癫痫状况进行分类并确定其病因。提供发作间期癫痫样放电的常规或睡眠脑电图有助于鉴别诊断。为了在实际发作期间获得脑电图记录，通常使用动态设备或脑电图-视频程序进行长期记录。脑电图和视频记录相结合，使用表面电极或手术植入电极，在评估药物治疗难治的患者以及可能适合癫痫手术的患者时是一项至关重要的程序。在怀疑由肿瘤或脑血管疾病引起的癫痫病例中，神经学检查与这些疾病的常规检查无异。磁共振成像（MRI）技术已成为慢性药物难治性部分性癫痫术前评估的重要辅助手段。MRI还简化了导致部分性癫痫的微小形态异常的识别，是此类病例的首选方法。通过将MRI与体积测量和光谱学相结合，其敏感性得到了提高。在发作期间使用单光子发射计算机断层扫描（SPECT）和正电子发射断层扫描（PET）等功能神经成像可提供更多信息。一个有前景的新进展是MRI与功能成像（脑电图棘波和发作模式的偶极重建、SPECT、PET）的联合注册。MRI是术前评估的基石，但诊断和治疗方法的选择始终基于临床表现、脑电图以及功能和形态成像。
