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The Diagnostic Value of MRI Brain Epilepsy Protocol in Evaluation of Adults with Seizures

القيمة التشخيصية لبروتوكول الصرع في الرنين المغناطيسي للدماغ في تقييم النوبة الاختلاجية عند البالغين

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 Publication date 2021
  fields Medicine
and research's language is العربية
 Created by Shamra Editor




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Background and objectives: The advent of high-resolution MRI with a dedicated epilepsy protocol improves the ability to identify possible structural abnormalities that underlie seizure disorders. The aims of this study were to evaluate the diagnostic efficacy of standard MRI, identify whether there is an increase in the diagnostic yield with the addition of dedicated seizure protocol, and compare the diagnostic yields of MRI and electroencephalogram (EEG) individually and in combination. Subjects and Methods: This was a cross-sectional analytic study, included 100 cases who presented with seizure over 18 months. Patients underwent complete neurological examination, EEG, and MRI with a standard and dedicated epilepsy protocol. Results: We found epileptogenic lesions in MRI in 55.5. Mesial temporal lobe sclerosis was the most common epileptogenic lesion (45.5%). The diagnostic efficacy of MRI had increased with dedicated epilepsy protocol compared to standard protocol. Abnormal MRI and EEG were compatible in 21%. Conclusion and implications: Dedicated epilepsy protocol increased the diagnostic efficacy of brain MRI in detecting a structural epileptogenic lesion, with 100% of mesial temporal sclerosis, the most common lesion in our study, was detected only in dedicated epilepsy protocol and missed in standard protocol.


Artificial intelligence review:
Research summary
تتناول هذه الدراسة القيمة التشخيصية لبروتوكول الصرع في التصوير بالرنين المغناطيسي للدماغ في تقييم النوبات الاختلاجية عند البالغين. تهدف الدراسة إلى تقييم كفاءة الرنين المغناطيسي القياسي، وتحديد ما إذا كان هناك زيادة في القيمة التشخيصية باستخدام البروتوكول الخاص بالصرع، ومقارنة القيمة التشخيصية لكل من الرنين المغناطيسي وتخطيط الدماغ الكهربي (EEG) لدى البالغين الذين يعانون من نوبات اختلاجية. شملت الدراسة 100 حالة ممن راجعوا العيادة العصبية في مشفى تشرين الجامعي في اللاذقية وعانوا من نوبات اختلاجية خلال الأشهر الـ 18 السابقة. أظهرت النتائج وجود آفات صرعية في الرنين المغناطيسي بنسبة 55.5%، وكانت تصلب الفص الصدغي الأنسي الآفة الأكثر تواتراً بنسبة 45.5%. ازدادت القيمة التشخيصية للرنين المغناطيسي باستخدام البروتوكول الخاص بالصرع مقارنة مع البروتوكول القياسي، حيث توافق الرنين المغناطيسي مع تخطيط الدماغ الكهربي في 21% من الحالات. خلصت الدراسة إلى أن البروتوكول الخاص بالصرع يزيد من القيمة التشخيصية للرنين المغناطيسي في الكشف عن الآفات الصرعية البنيوية، مما يساهم في تحسين التشخيص والتدبير المبكر للمرضى.
Critical review
دراسة نقدية: تعد الدراسة ذات أهمية كبيرة في مجال تشخيص النوبات الاختلاجية، حيث تقدم دليلاً قوياً على فعالية البروتوكول الخاص بالصرع في تحسين القيمة التشخيصية للرنين المغناطيسي. ومع ذلك، يمكن توجيه بعض النقد البناء للدراسة. أولاً، حجم العينة قد يكون غير كافٍ لتعميم النتائج على جميع المرضى، لذا يفضل إجراء دراسات مستقبلية تشمل عينات أكبر. ثانياً، لم تتناول الدراسة بشكل كافٍ العوامل البيئية والجغرافية التي قد تؤثر على نتائج التشخيص، مما قد يحد من تطبيق النتائج في سياقات مختلفة. أخيراً، كان من الممكن أن تكون الدراسة أكثر شمولية إذا تضمنت مقارنة بين تقنيات تصوير أخرى مثل التصوير المقطعي المحوسب (CT) لتقديم صورة أكثر تكاملاً عن فعالية البروتوكولات المختلفة.
Questions related to the research
  1. ما هي الأهداف الرئيسية للدراسة؟

    الأهداف الرئيسية للدراسة هي تقييم الكفاءة التشخيصية للرنين المغناطيسي القياسي لدى مرضى النوبات الاختلاجية، وتحديد ما إذا كان هناك زيادة في القيمة التشخيصية باستخدام البروتوكول الخاص بالصرع، ومقارنة القيمة التشخيصية لكل من الرنين المغناطيسي وتخطيط الدماغ الكهربي لدى البالغين الذين يعانون من نوبات اختلاجية.

  2. ما هي النتيجة الرئيسية التي توصلت إليها الدراسة؟

    النتيجة الرئيسية التي توصلت إليها الدراسة هي أن البروتوكول الخاص بالصرع يزيد من القيمة التشخيصية للرنين المغناطيسي في الكشف عن الآفات الصرعية البنيوية، حيث أظهر البروتوكول الخاص بالصرع توافقاً أكبر مع تخطيط الدماغ الكهربي مقارنة بالبروتوكول القياسي.

  3. ما هي الآفة الصرعية الأكثر شيوعاً التي تم اكتشافها في الدراسة؟

    الآفة الصرعية الأكثر شيوعاً التي تم اكتشافها في الدراسة هي تصلب الفص الصدغي الأنسي، والتي شكلت 45.5% من الحالات التي أظهرت آفات صرعية في الرنين المغناطيسي.

  4. ما هي التوصيات التي خلصت إليها الدراسة؟

    خلصت الدراسة إلى توصية بإجراء المزيد من الدراسات الموسعة التي تشمل عدداً أكبر من المرضى وتبحث في كل آفة من الآفات الصرعية على حدة، نظراً للأهمية الواضحة للرنين المغناطيسي في تقييم مرضى النوبات الاختلاجية. كما أوصت بربط نتائج التصوير الطبي مع نتائج تخطيط الدماغ الكهربي والفحص العصبي الكامل للوصول إلى التقييم الأمثل والتدبير الأفضل.


References used
Annegers JF, Hauser WA, Lee JR, Rocca WA. Incidence of acute symptomatic seizures in Rochester, Minnesota, 1935 - 1984. Epilepsia 1995; 36:327
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