Trends in presurgical evaluation and surgical treatment of epilepsy at one centre from 1988-2009
Trends in presurgical evaluation and surgical treatment of epilepsy at one centre from 1988-2009
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DOI：
10.1136/jnnp-2011-301763
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发表时间：
2013-01-01
影响因子：
11
通讯作者：
Elger, Christian E.
中科院分区：
文献类型：
--
作者：
Bien, Christian G.;Raabe, Anna L.;Elger, Christian E.
背景癫痫的术前诊断和外科治疗已成为神经病学的标准程序。在这里，我们报告术前患者分组根据其基础病理的术前评估，手术治疗和长期随访的结果，1989 - 2009年之间，并描述在此期间的趋势。结果2684例术前患者进行了术前检查，其中1721例（64.1%）进行了切除手术。最大的术前/手术组是中颞叶癫痫伴海马硬化（29.5%/35.4%）。在所有手术患者中，1160例（67.4%）的随访时间>= 2年。共有586例持续无先兆癫痫（50.5%;良性肿瘤：61.0%;局灶性皮质发育不良：57.6%;中颞叶癫痫伴海马硬化：49.4%;非病灶性：27.6%）。根据术前研究的患者数量，我们计算出术前/手术方案效果的新指标，"意向治疗无并发症"率为32.4%。随着时间的推移，接受评估的患者数量以及不适合或不同意采取侵入性措施的患者数量有所增加。切除手术的年数量保持稳定。接受术前评估的患者的平均癫痫持续时间增加。良性肿瘤患者的比例下降。颅内研究和MRI-组织病理学差异减少。癫痫手术是非常有效的，特别是在明确定义的局灶性病变的患者。在这个专门的中心，有一个趋势，越来越多的困难患者和增加癫痫持续时间之前，转诊进行术前评估。
Background Presurgical epilepsy diagnostics and surgical treatment have become standard procedures of neurology. Here, we report on presurgical patients grouped according to their underlying pathology by giving results of presurgical evaluation, surgical therapy and long-term follow-up between 1989-2009 and describe trends over this period.Patients and methods Data of prospectively documented presurgical patients were retrospectively analysed. Trends were evaluated by a year-by-year analysis.Results 2684 presurgical patients underwent presurgical work-up, 1721 of whom (64.1%) went on to resective surgery. The largest presurgical/surgical group was mediotemporal lobe epilepsy with hippocampal sclerosis (29.5%/35.4%). Of all operated patients, 1160 (67.4%) had a follow-up of >= 2 years. A total of 586 were continuously seizure-free without auras (50.5%; benign tumours: 61.0%; focal cortical dysplasia: 57.6%; mediotemporal lobe epilepsy with hippocampal sclerosis: 49.4%; non-lesional: 27.6%). Based on the number of the presurgically studied patients, we calculated as a novel measure of the effect of a presurgical/surgical programme an 'intention-to treat seizure-freedom' rate of 32.4%. Over time, the number of patients undergoing evaluation, but also of those not suitable or agreeable for invasive measures increased. Annual numbers of resective procedures remained stable. Average epilepsy duration of patients admitted for presurgical assessment increased. The proportion of patients with benign tumours declined. Intracranial studies and MRI-histopathology discrepancies decreased. Seizure-freedom rates remained constant.Conclusions Epilepsy surgery is highly effective, especially in patients with clearly defined focal pathologies. At this specialised centre, there is a trend towards growing numbers of difficult patients and increasing epilepsy duration prior to referral for presurgical assessment.