Clinical outcomes after corpus callosotomy in patients with bihemispheric malformations of cortical development
Clinical outcomes after corpus callosotomy in patients with bihemispheric malformations of cortical development
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DOI：
10.3171/ped.2004.101.2.0007
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发表时间：
2004-08-01
影响因子：
4.1
通讯作者：
Tamagawa, K
中科院分区：
文献类型：
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作者：
Kawai, K;Shimizu, H;Tamagawa, K
对象。癫痫患者的双半球皮质发育畸形（MCD）是典型的医学难治性。有报道称局灶性切除无效。胼胝体切开术一直被提倡作为一种治疗选择，但结果只在几个病例报告中报道。作者描述了10例双脑性mcd患者，他们接受了全胼胝体切开术。这些患者的mcd包括无脑畸形、带状异位、周围型多小回畸形和结节性硬化症。术前所有患者均出现致残性跌落发作或剧烈的头跌落发作，并造成频繁的身体损伤。随访时间为1.4 ~ 5.8年（中位3.2年）。术后评估癫痫发作结局、家长日常功能评估及家长对结果的满意度。在整个随访期间，8例患者的下降发作完全消失，1例患者下降到基线的10%以下。其他类型的癫痫发作在1例患者中完全消失，在7例患者中减少。整体的日常功能得到改善，家长对所有患者的手术相关结果都很满意，除了一位复发的患者。在任何病例中，没有明显和持续的神经功能缺损的迹象。在大多数双半球mcd患者中，全胼胝体切开术的结果是有利的。该程序对造成这些患者身体伤害和生活质量受损的跌落攻击特别有效。
Object. Epilepsy in patients with bihemispheric malformations of cortical development (MCD) is typically medically intractable. Focal resection has been reported to be ineffective. Corpus callosotomy has been advocated as a treatment option, but the results have been reported only in several case reports. The authors describe a series of 10 patients with biltemispheric MCDs who underwent total corpus callosotomy.Methods. The MCDs in these patients included lissencephaly, band heterotopia, perisylvian polymicrogyria, and tuberous sclerosis. Preoperatively all patients suffered disabling drop attacks or intense head drop seizures that caused frequent physical injuries. The follow-up period ranged from 1.4 to 5.8 years (median 3.2 years). Seizure outcome, parental assessment of daily function, and parental satisfaction with outcome were assessed postoperatively. Drop attacks disappeared completely during the entire follow-up period in eight patients and decreased to less than 10% of baseline in one. Other types of seizures were resolved completely in one patient and decreased in seven. Overall daily function improved and parents were satisfied with the surgery-related results in all patients except one who experienced a recurrence of drop attacks. There were no signs of significant and persistent neurological deficits in any case.Conclusions. Results of total corpus callosotomy in patients with bihemispheric MCDs were favorable in most cases. The procedure was particularly effective against drop attacks causing physical injuries and impaired quality of life in these patients.