Seizure outcome after epilepsy surgery in children and adolescents
Seizure outcome after epilepsy surgery in children and adolescents
复制标题
DOI：
10.1002/ana.410440507
复制
发表时间：
1998-11
影响因子：
11.2
通讯作者：
E. Wyllie;Y. Comair;P. Kotagal;Juan Bulacio;W. Bingaman;P. Ruggieri
中科院分区：
文献类型：
--
作者：
E. Wyllie;Y. Comair;P. Kotagal;Juan Bulacio;W. Bingaman;P. Ruggieri
从儿科患者系列中获得的癫痫手术结局数据很少。我们研究了1990年1月至1996年6月期间在克利夫兰诊所接受难治性癫痫手术的136例儿科患者的癫痫发作结局，术后随访1至7.5年（平均3.6年）。将62名儿童（手术时3个月至12岁）与74名青少年（13-20岁）进行了比较。儿童（50%）和青少年（44%）的颞外或多叶切除术和大脑半球切除术的发生率相似，但这些手术主要发生在婴儿期（90%的0-2岁患者）。其余患者行颞叶切除术。皮质发育不良和低级别肿瘤是最常见的原因，海马硬化罕见。总体而言，69%的青少年、68%的儿童和60%的婴儿亚组实现了无癫痫发作结局;颞叶切除术后，31名儿童中的23名（74%）和41名青少年中的33名（80%）实现了无癫痫发作结局;颞外或多叶切除术后，19名儿童中的11名（58%）和29名青少年中的15名（52%）实现了无癫痫发作结局;功能性大脑半球切除术后12例儿童中8例（67%），4例青少年中3例（75%）。颞叶切除术后的无癫痫结局（56/72，78%）比颞外或多叶切除术后（26/48，54%; 41/48例磁共振成像显示局灶性病变）更常见，肿瘤患者（36/44，82%）与皮质发育不良患者（16/31，52%）相比也更常见。婴儿、儿童和青少年癫痫手术后无癫痫发作结局的频率相似，与成人系列的结果相当。每个年龄、手术类型和病因组的大多数患者在手术后均未发生癫痫发作。这些结果表明，无论儿童表现为严重、难治性、致残性定位相关癫痫，都应考虑对其进行手术评估。
Few epilepsy surgery outcome data are available from series of pediatric patients. We studied seizure outcome in 136 pediatric patients who had surgery for intractable epilepsy at The Cleveland Clinic between January 1990 and June 1996, with a postoperative follow‐up of 1 to 7.5 years (mean, 3.6 years). Sixty‐two children (3 months to 12 years old at time of surgery) were compared with 74 adolescents (13–20 years old). Extratemporal or multilobar resections and hemispherectomies were similarly frequent among children (50%) and adolescents (44%), but these procedures strongly predominated in infancy (90% of patients 0–2 years of age). The remaining patients had temporal resection. Cortical dysplasia and low‐grade tumor were the most common causes and hippocampal sclerosis was rare. Seizure‐free outcome was achieved for 69% of adolescents, 68% of children, and 60% of the infant subgroup, overall; for 23 (74%) of 31 children and 33 (80%) of 41 adolescents after temporal resection; for 11 (58%) of 19 children and 15 (52%) of 29 adolescents after extratemporal or multilobar resection; and for 8 (67%) of 12 children and 3 (75%) of 4 adolescents after functional hemispherectomy. Seizure‐free outcome was more frequent after temporal resection (56 of 72, 78%) than after extratemporal or multilobar resection (26 of 48, 54%; 41 of 48 with a focal lesion on magnetic resonance imaging), and among patients with tumor (36 of 44, 82%) versus cortical dysplasia (16 of 31, 52%). The frequency of seizure‐free outcome after epilepsy surgery was similar for infants, children, and adolescents, and comparable with results from adult series. Most patients in each age, surgery type, and causal group were free from seizures after surgery. These results suggest that children should be considered for surgical evaluation at whatever age they manifest with severe, intractable, disabling localization‐related epilepsy.