European trends in epilepsy surgery
European trends in epilepsy surgery
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DOI：
10.1212/wnl.0000000000005776
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发表时间：
2018-07-10
期刊：
影响因子：
9.9
通讯作者：
Seeck, Margitta
中科院分区：
文献类型：
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作者：
Baud, Maxime O.;Perneger, Thomas;Seeck, Margitta
目的切除手术可有效治疗耐药性局灶性癫痫，但仍不清楚改进的诊断是否会影响术后结果。在这里，我们比较了相隔 15 年的 2 个时期的实践和结果。方法 16 个欧洲中心回顾性确定了 2 组在 1997 年至 1998 年 (n = 562) 或 2012 年至 2013 年 (n = 736) 期间接受癫痫手术的儿童和成人。收集的数据包括患者（性别、年龄）和疾病（持续时间、定位和诊断）特征、手术类型、组织病理学、恩格尔术后结果和并发症，以及对每个病例进行的影像学和电生理测试。术后结果预测因素被纳入多变量逻辑回归中，以评估手术日期作为独立预测因素的强度。结果随着时间的推移，每个中心的手术病例数从每 2 年期间的中位数 31 例增加到 50 例 (p = 0.02)。手术时的平均病程缩短了 5.2 年 (p < 0.001)。尽管复杂手术（颞外和/或 MRI 阴性）有所增加，但总体无癫痫发作（Engel 1 级）从 66.7% 增加至 70.9%（调整后 p = 0.04）。与早期手术相比，后期进行的手术产生有利结果（恩格尔 I 级）的可能性是早期手术的 1.34 倍（调整后优势比；95% 置信区间 1.02-1.77），并且颞外癫痫和 MRI 阴性颞叶癫痫的改善更为显着。持续性神经系统并发症的发生率保持稳定（4.6%-5.3%，p = 0.7）。 结论 随着时间的推移，欧洲癫痫手术的改善虽然不大，但意义重大，包括手术量更大、疾病持续时间更短以及术后癫痫结果改善。为了继续这一令人鼓舞的趋势，需要尽早转介进行评估。
ObjectiveResective surgery is effective in treating drug-resistant focal epilepsy, but it remains unclear whether improved diagnostics influence postsurgical outcomes. Here, we compared practice and outcomes over 2 periods 15 years apart.MethodsSixteen European centers retrospectively identified 2 cohorts of children and adults who underwent epilepsy surgery in the period of 1997 to 1998 (n = 562) or 2012 to 2013 (n = 736). Data collected included patient (sex, age) and disease (duration, localization and diagnosis) characteristics, type of surgery, histopathology, Engel postsurgical outcome, and complications, as well as imaging and electrophysiologic tests performed for each case. Postsurgical outcome predictors were included in a multivariate logistic regression to assess the strength of date of surgery as an independent predictor.ResultsOver time, the number of operated cases per center increased from a median of 31 to 50 per 2-year period (p = 0.02). Mean disease duration at surgery decreased by 5.2 years (p < 0.001). Overall seizure freedom (Engel class 1) increased from 66.7% to 70.9% (adjusted p = 0.04), despite an increase in complex surgeries (extratemporal and/or MRI negative). Surgeries performed during the later period were 1.34 times (adjusted odds ratio; 95% confidence interval 1.02-1.77) more likely to yield a favorable outcome (Engel class I) than earlier surgeries, and improvement was more marked in extratemporal and MRI-negative temporal epilepsy. The rate of persistent neurologic complications remained stable (4.6%-5.3%, p = 0.7).ConclusionImprovements in European epilepsy surgery over time are modest but significant, including higher surgical volume, shorter disease duration, and improved postsurgical seizure outcomes. Early referral for evaluation is required to continue on this encouraging trend.