A Study Of Clinical Semiology In Epilepsy And Its Correlation With EEG, MRI And SPECT

Ojective:This study aims to determine the features of clinical semiology in epilepsy, the clinical utility of EEG,as well as the commom findings on MRI,their correlation with epilepsy.We want to review the value of combination of EEG,MRI and SPECT in the diagnosis and treatment of epilepsy.Material and Methods:399 epileptic patients(238male and 161 female) were included in our study.Review the medical history of each patient,including gender,age,age of onset,course of disease and so on.Classify the epileptic seizures and epileptic syndromes according to the seizure classification introduced in ILAE1981. 352 patients were investigated with noninvasive EEG,282patients were investigated with MRI,and 189 patients were investigated with SPECT.Results:1.Clinical characteristis of epilepsy:The age of patients ranged from 5.0 to 83.0 years(median age 23.0 years).The age at seizure onset ranged from 0.0 to 82.0 years(median age 18.0 years).The duration of the epilepsy was 0.0 to 50.0 years (median 2.0 years).The age at seizure onset had a peak at about 18 years.A total of 87 patients were considered idiopathic epilepsy,268 symptomatic epilepsy,44 cryptogenic epilepsy.According to the medical history,tests and effects to AEDs, 5 patients were considerded LGS,8 benign childhood epilepsy with centrotemporal spike,3 JME.Focal seizure was the most common type(70.9%), especially in symptomatic epilepsy(the ratio was up to 81.0%).54.4%of all the patients only had one clinical presentation,and 36.3%had two clinical presentations,9.3%had more than two presentations.The seizure frequence was significantly lower in idiopathic epilepsy than that in symptomatic and cryptogenic epilepsy(p=0.034).The frequence of generalized seizures was significantly lower than that in focal seizures(p=0.047).2.Correlation between semiology and EEG:Scalp EEG were studied in 352 patients, 69.9%of which showed seizure patterns,and 6.8%of which had been captured seizure onset.The higher of the seizure frequence,the higher of the sensitivity of EEG(p=0.001).There were no significantly difference of the sensitivity of EEG between focal and generalized seizures.Focal epileptiform discharges were more frequently present in focal seizure(p=0.007),while generalized epilepticform discharges were more frequently present in generalized seizures(p-0.000). Interictal epileptiform discharges(IEDs) were seen in 66.7%of SPS,84.7%of CPS,and 69.3%of SGTC.3.MRI performance:MRI were studied in 282 patients,49.3%of which found lesions on MRI.The MRIs were classified in the following pathology:47(16.7%) lacunar infarction,37(13.1%) abnormal signal and 20 of that considered to be infection,18(6.4%) hippocampus sclerosis,15(5.3%) brain atrophy,14(5.0%) cysts,13(4.6%) cortical dysplasia,8(2.8%) hematoma,8(2.8%) glioma,5(1.8%) cavernons hemangioma,5(1.8%) Melas,5(1.8%) ischemic stroke.Abnormalitis found in less than 1%including vascular malformations,scars,custicerciasis, demyelination,vasculitis and so on.23 patients showed two different pathologic changes,most of that were lacunar infarction combined with other types.4.Correlation between semiology and MRI:Compared with the patients with generalized seizures,sensitivities were higher in focal seizures(p=0.041). Asymmetry abnomalities were more common in focal seizures(p=0.035).The lesions on MRI had no relation with seizure freguence.5.Correlation between semiology and SPECT:SPECT were studied in 189 patients, 45.0%of which had found regionalized abnormalties.79 patients showed low perfusion,6 patients showed hyperperfusion.Sensitivity of SPECT had no significant difference between focal and generalized seizures(48.6%vs 35.0%, p=0.130).But the sensitivity was different in idiopathic,symptomatic and cryptogenic epilepsy(18.0%vs 57.9%vs 32.3%,p=0.000).SPECT sensitivity was not related to seizure frequence(p=0.299).6.The combined value of EEG,MRI and SPECT in the location or lateralization of epileptic seizures:189 patients had undergone EEG,MRI and SPECT,11.6%of all patients had concordant results of EEG and MRI,12.7%of all patients had concordant results of EEG and SPECT,16.4%of all patients had concordant results of MRI and SPECT.In 5.3%of all patients,the three invalsive tests indicated to the same lesions.Conclusions:There were many kinds of seizure types,and half of the patients suffered from epilepsy had more than one seizure type.Focal seizures were the most common performance.Seizure frequence was associated with etiology and seizure types.EEG had important role in the diagnosis and classification in epilepsy.The lesions on MRI were not equal to epileptogenic regions.We must clear the causation while facing epilepsy and MRI abnormalities.The sensitivity of SPECT had correlation with epileptic etiology.Clinicians must standardize the medical history taking,take normative EEG,MRI and SPECT tests.The three tests should be combined to analysis the semiology,location and lateralization of epilepsy.