Epilepsy Surgery for Pharmacoresistant Temporal Lobe Epilepsy A Decision Analysis
Epilepsy Surgery for Pharmacoresistant Temporal Lobe Epilepsy A Decision Analysis
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DOI：
10.1001/jama.2008.771
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发表时间：
2008-12-03
影响因子：
120.7
通讯作者：
Wong, John B.
中科院分区：
文献类型：
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作者：
Choi, Hyunmi;Sell, Randall L.;Wong, John B.
背景与一般人群相比，耐药癫痫患者的死亡率增加，但是那些有抗药性的颞叶癫痫患者，如果他们符合手术的标准，目的量化前颞叶切除术对耐药性颞叶癫痫患者的潜在生存益处，继续医疗管理。设计Monte Carlo模拟模型，将可能的手术并发症和癫痫发作状态纳入其中，运行10 000次。该模型填充有直接从患者获得的健康相关生活质量数据和来自医学文献的数据。结果与内科治疗相比，对一名35岁的前颞叶癫痫患者行前颞叶切除术可使其生存期延长5.0年（95% CI，2.1- 9.2），在100%的模拟中首选手术。前颞叶切除术可使质量调整预期寿命增加7.5质量调整预期寿命年（95%，CI，-0.8至17.4），96.5%的模拟中首选手术，主要是由于没有致残性癫痫发作的时间增加，从而降低了癫痫发作相关的过度死亡率并改善了生活质量。结果是强大的敏感性analysis.Conclusion的决策分析模型表明，平均前颞叶切除术应提供大量的收益，在预期寿命和质量调整后的预期寿命与药物耐药性颞叶癫痫患者手术治疗相比。
Context Patients with pharmacoresistant epilepsy have increased mortality compared with the general population, but patients with pharmacoresistant temporal lobe epilepsy who meet criteria for surgery and who become seizure- free after anterior temporal lobe resection have reduced excess mortality vs those with persistent seizures.Objective To quantify the potential survival benefit of anterior temporal lobe resection for patients with pharmacoresistant temporal lobe epilepsy vs continued medical management.Design Monte Carlo simulation model that incorporates possible surgical complications and seizure status, with 10 000 runs. The model was populated with health-related quality- of- life data obtained directly from patients and data from the medical literature. Insufficient data were available to assess gamma- knife radiosurgery or vagal nerve stimulation.Main Outcome Measures Life expectancy and quality- adjusted life expectancy.Results Compared with medical management, anterior temporal lobe resection for a 35- year- old patient with an epileptogenic zone identified in the anterior temporal lobe would increase survival by 5.0 years ( 95% CI, 2.1- 9.2) with surgery preferred in 100% of the simulations. Anterior temporal lobe resection would increase qualityadjusted life expectancy by 7.5 quality- adjusted life- years ( 95%, CI, - 0.8 to 17.4) with surgery preferred in 96.5% of the simulations, primarily due to increased years spent without disabling seizures, thereby reducing seizure- related excess mortality and improving quality of life. The results were robust to sensitivity analyses.Conclusion The decision analysis model suggests that on average anterior temporal lobe resection should provide substantial gains in life expectancy and qualityadjusted life expectancy for surgically eligible patients with pharmacoresistant temporal lobe epilepsy compared with medical management.