- 期刊
Magnetic Resonance Imaging in Symptomatic/Cryptogenic Partial Epilepsies of Infants and Children
兒童症候／隱因型局部癲癇的磁振造影研究
摘要
爲了探討兒童症候／隱因型局部癲癇的病因，我們在過去七年中前膽性研究了300名患有症候／隱因型局部癲癇兒童的磁振造影、神經學及腦波變化。磁振造影異常的檢出率是41.7%(125／300)。特定的原因，如腦先天發育畸形(18名)、腦血管畸形(9名)、神經皮膚症候群(13名)及腦佔據性病變(20名)，有相當高的比率。一些非特定性病因，如感染、缺氧、腦出血、外傷及代謝疾病可造成腦實質破壞病竈，如孔腦症、腦萎縮(20名)。而外傷、缺氧、紅斑性狼瘡、腦炎、腦栓塞、血管病變及心臟疾病可造成腦梗塞、腦灰質或白質軟化(22名)，這些都可導致局部癲癇。另外20%的顳葉癲癇病童，在磁振造影可見內側顳葉硬化理象，其中一半的病童有早期熱性抽筋的病史。其他顳葉癲癇的磁振變化如孔腦症、髓鞘化遲緩則與腦缺血一缺氧病變比較具相關性。 症候型局部癲癇常反應腦有局部病竈；磁振造影可檢測出許多基礎疾病。他們常常可以用外科療法耿根治其基礎病因或控制其頑固性癲癇的發作。我們建議所有症候／隱因型局部癲癇病人，都需以詳實的臨床及腦波評估，再配合磁振掃描，以發現基礎病因，予以妥善治療。
並列摘要
In order to identify the brain lesions of symptomatic/crypto genie partial epilepsies (S/CPE(subscript s)) in infants and children, magnetic resonance imaging (MRI) studies, thorough encephalographic (EEGic) studies, and detailed clinical and neurologic evaluations were obtained in 300 infants and children who were diagnosed to have S/CPE(subscript s) with onset before the age of 13 years during the past 7 years. The overall detection rate of brain lesions by MRI was 41.7% (125/ 300). Congenital malformations (18 cases), vascular malformations (9 cases), neurocutaneous syndromes (13 cases), and space-taking lesions (20 cases) constitute a large percentage of SPEs in infants and children. A variety of insults such as infection, ischemia, hemorrhage, trauma and metabolic disorders can result in destructive parenchymal loss lesions including porencephaly, focal atrophy, hemiatrophy, and diffuse brain atrophy (20 cases). Major etiologic factors leading to infarction. encephalomalacia, leukomalacia, included trauma, hypoxicischemic encephalopathy (HIE), systemic lupus erythematosus (SLE), encephalitis, vasculitis, venous thrombosis, vasculopathies, and heart problems (22 cases). Mesial temporal sclerosis (MTS) could be evidenced in around 20% (18/95) of cases with temporal lobe epilepsy (TLE), which was strongly associated with past histories of febrile seizures and encephalitis complicated by status epileptics. However, cases with porencephaly, global atrophy or delayed myelination of unilateral temporal lobe on MRI were more related to HIE. With the advent of neuroimaging techniques, particularly MRJ, a wide variety of underlying pathology can be detected as a cause of symptomatic partial epilepsies in pediatric patients. The occurrence of S/CPE indicates the presence of localized brain dysfunction, and many of the causes are potentially treatable. An orderly and thorough clinical and laboratory investigations, as well as neuroimaging studies should be made to diagnose and treat any underlying conditions.