Epileptology of the first-seizure presentation: a clinical, electroencephalographic, and magnetic resonance imaging study of 300 consecutive patients

被引:409
作者
King, MA
Newton, MR
Jackson, GD
Fitt, GJ
Mitchell, LA
Silvapulle, MJ
Berkovic, SF [1 ]
机构
[1] Austin & Repatriat Med Ctr, Dept Neurol, Melbourne, Vic 3084, Australia
[2] Univ Melbourne, Dept Med, Melbourne, Vic, Australia
[3] Austin & Repatriat Med Ctr, Dept Radiol, Melbourne, Vic 3084, Australia
[4] La Trobe Univ, Dept Stat Sci, Bundoora, Vic, Australia
关键词
D O I
10.1016/S0140-6736(98)03543-0
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background Prognosis and treatment of the first seizure depends on identification of a specific epilepsy syndrome, yet patients with first seizures are generally regarded as a homogeneous group. We studied whether it is possible to diagnose specific epilepsy syndromes promptly by use of standard clinical methods, electroencephalography (EEG) and magnetic resonance imaging (MRI). Methods 300 consecutive adults and children presented with unexplained seizures, We systematically collected clinical data from patients and witnesses. and attempted to obtain an EEG within 24 h of the seizure. Where the EEG was negative, a sleep-deprived EEG was done. MRI was done electively. Findings A generalised or partial epilepsy syndrome was clinically diagnosed in 141 (47%) patients. Subsequent analysis showed that only three of these clinical diagnoses were incorrect, Addition of the EEG data enabled us to diagnose an epilepsy syndrome in 232 (77%) patients. EEG within 24 h was more useful in diagnosis of epileptiform abnormalities than later EEG (51 vs 34%). Neuroimaging showed 38 epileptogenic lesions, including 17 tumours. There were no lesions in patients for whom generalised epilepsy was confirmed by EEG. Our final diagnoses were: generalised epilepsy (23% of patients); partial epilepsy (58%); and unclassified (19%). Interpretation An epilepsy syndrome can be diagnosed in most first-seizure patients. Ideally, an EEG should be obtained within 24 h of the seizure followed by a sleep deprived EEG if necessary. MRI aids diagnosis and should be done for ail patients except for those with idiopathic generalised epilepsies and for children with benign rolandic epilepsy.
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页码:1007 / 1011
页数:5
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