A longitudinal study of surgical outcome of pharmacoresistant epilepsy caused by focal cortical dysplasia
A longitudinal study of surgical outcome of pharmacoresistant epilepsy caused by focal cortical dysplasia
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局灶性皮质发育不良所致耐药性癫痫手术疗效的纵向研究
DOI：
10.1007/s00415-016-8274-1
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发表时间：
2016-12-01
影响因子：
6
通讯作者：
Chen, Shuhua
中科院分区：
文献类型：
--
作者：
Jin, Bo;Wang, Jing;Chen, Shuhua
本研究旨在确定局灶性皮质发育不良（FCD）引起的耐药性癫痫的长期手术结果，并确定良好手术结果的重要预测因素。该研究回顾性分析了我院癫痫中心2010年5月至2014年12月期间经组织学证实为FCD的耐药性癫痫患者的数据。共纳入120例患者，平均随访时间为34.6个月。使用生存分析和 Cox 比例风险模型的多变量回归来评估无癫痫发作的发生率、稳定性和预测因素。术后 1 年预计无癫痫发作的几率为 73.0% [95% CI, 65.2-80.8%]，2 年时为 70.0% (95% CI, 62.2-77.8%)，5 年及以上时为 65% (95% CI, 53.2-76.7%)。大多数癫痫发作复发（85.7%）发生在术后 12 个月内。 FCD 切除不完全、术后 3-6 个月脑电图 (EEG) 出现发作间期癫痫样放电 (IED) 以及术后习惯性急性癫痫发作 (APOS) 是癫痫复发的独立预测因素。然而，其他因素，例如FCD类型和睡眠相关癫痫，并没有显着影响手术结果。在成为耐药性癫痫之前，30 名患者 (25%) 对抗癫痫药物有反应，且无癫痫发作持续时间超过 1 年。 FCD患者的手术结果良好，与发达国家报道的结果相当。 FCD 切除不完全、术后 3-6 个月脑电图存在 IED 以及习惯性 APOS 是术后癫痫复发的有力预测因素。
This study aimed to determine the long-term surgical outcome of pharmacoresistant epilepsy caused by focal cortical dysplasia (FCD) and to identify the important predictors of the favorable surgical outcome. The study retrospectively analyzed the data of pharmacoresistant epilepsy patients with histologically proven FCD in our epilepsy center from May 2010 to December 2014. It included 120 patients with a mean follow-up of 34.6 months. Survival analysis and multivariate regression with Cox proportional hazards model were used to evaluate the rate, stability, and predictors of seizure freedom. The estimated chance of seizure freedom was 73.0 % [95 % confidence intervals (CI), 65.2-80.8 %] at 1 year after surgery, 70.0 % (95 % CI, 62.2-77.8 %) at 2 years, and 65 % (95 % CI, 53.2-76.7 %) at 5 years and beyond. Most seizure recurrences (85.7 %) happened within 12 months after surgery. The incomplete resection of FCD, presence of interictal epileptiform discharges (IEDs) on 3-6 months postoperative electroencephalography (EEG), and presence of habitual acute postoperative seizure (APOS) were independent predictors of seizure recurrence. However, other factors, such as the FCD type and sleep-related epilepsy, did not significantly influence the surgical outcome. Before becoming pharmacoresistant epilepsy, 30 (25 %) patients responded to antiepileptic drugs with a seizure-free duration of more than 1 year. The surgical outcome is favorable in patients with FCD, which is comparable to that reported in developed countries. The incomplete resection of FCD, presence of IEDs on 3-6 months postoperative EEG, and presence of habitual APOS are powerful predictive factors for seizure recurrence after surgery.