Does Adjustment of Antiseizure Medication Regimen after Failed Epilepsy Surgery Improve Outcomes?
Does Adjustment of Antiseizure Medication Regimen after Failed Epilepsy Surgery Improve Outcomes?
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DOI：
10.3390/medicina59040785
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发表时间：
2023-04-18
期刊：
影响因子：
--
通讯作者：
Zhai X
中科院分区：
文献类型：
--
作者：
Wu Y;Zhang Z;Liang P;Li L;Zou B;Wang D;Dong X;Tang H;Qiu H;Zhai X
背景与目的：癫痫手术失败后，患者通常会恢复抗癫痫药物（ASM）ASM方案，可以通过三种方式进行调整或优化：增加剂量，替代疗法和联合疗法。目前尚不清楚哪种类型的抗癫痫药物调整方法可以改善结果。材料与方法：本队列纳入2015年1月至2021年12月在重庆医科大学儿童医院神经外科行癫痫切除手术失败的患儿，回顾其是否进行了增加剂量、替代治疗或联合治疗的ASM调整。评估癫痫发作结局和生活质量（QoL）。采用双尾Fisher精确检验和Mann-Whitney U检验进行统计分析。结果：63名手术失败的儿童被纳入进一步分析，中位随访时间为53个月。中位癫痫复发时间为4个月。末次随访时，36.5%（n = 23）的患者实现了癫痫发作无发作，41.3%（n = 26）的患者实现了癫痫发作缓解，61.9%（n = 39）的患者生活质量良好。三种类型的ASM调整都没有改善儿童的结局，无论是在无癫痫率、癫痫缓解率还是生活质量方面。早期复发与无癫痫发作（p = 0.02）、癫痫缓解（p = 0.02）和良好生活质量（p = 0.01）的概率降低显著相关。结论：接受癫痫手术失败的儿童仍然有可能从ASM中获得晚期癫痫缓解。然而，调整ASM方案并没有增加癫痫缓解的可能性，也没有改善生活质量。临床医生应在手术失败后尽快完成评估并考虑是否需要其他抗癫痫治疗，特别是在处理早期复发的儿童时。
Background and Objectives: After failed epilepsy surgery, patients often revert to an antiseizure medication (ASM) ASM regimen, which can be adjusted or optimized in three ways: increasing the dose, alternative therapy, and combination therapy. It is unclear which type of antiseizure medication adjustment method can improve outcomes. Materials and Methods: Children who underwent failed epileptic resection surgery at the Department of Neurosurgery, Children’s Hospital of Chongqing Medical University between January 2015 and December 2021 were included in this cohort, who were reviewed for whether they underwent adjustment of ASM with increased dose, alternative therapy, or combination therapy. The seizure outcome and quality of life (QoL) were assessed. Two-tailed Fisher exact test and Mann–Whitney U test were used for statistical analysis. Results: Sixty-three children with failed surgery were included for further analysis, with a median follow-up time of 53 months. The median seizure recurrence time was 4 months. At the last follow-up, 36.5% (n = 23) of patients achieved seizure freedom, 41.3% (n = 26) achieved seizure remission, and 61.9% (n = 39) had a good QoL. None of the three types of ASM adjustment improved children’s outcomes, whether considered in terms of seizure-free rate, seizure remission rate, or QoL. Early recurrences were significantly associated with decreased probability of seizure freedom (p = 0.02), seizure remission (p = 0.02), and a good QoL (p = 0.01). Conclusions: Children who underwent failed epilepsy surgery remains some potential for late seizure remission from ASM. Yet adjusting ASM regimen does not increase the probability of seizure remission nor does it improve the QoL. Clinicians should complete evaluations and consider the need for other antiepileptic treatment as soon as possible after surgery failed, especially when dealing with children with an early recurrence.
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