Epilepsy control following intracranial monitoring without resection in young children
Epilepsy control following intracranial monitoring without resection in young children
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DOI：
10.1111/j.1528-1167.2011.03380.x
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发表时间：
2012-02-01
期刊：
影响因子：
5.6
通讯作者：
Weiner, Howard L.
中科院分区：
文献类型：
--
作者：
Roth, Jonathan;Olasunkanmi, Adeolu;Weiner, Howard L.
目的：颅内监测 (IM) 是特定难治性癫痫 (TRE) 患者的关键诊断程序。癫痫病灶切除可改善病变和非病变 TRE 的癫痫发作控制。 IM 本身不被认为具有治疗潜力。我们描述了一组在不进行切除手术的 IM 治疗后癫痫发作控制得到改善的患者。方法：在 12.5 年间，161 名儿童接受了 496 次手术，包括颅内监测。我们根据机构审查委员会批准的方案，回顾性审查了患者的病历、手术报告和放射学扫描。主要发现：17 名患者仅接受了 IM，没有进行额外的切除手术，其中 7 名患者的癫痫症状显着改善；七名患者中有六名没有癫痫发作（Engel I 级），一名患者很少癫痫发作（Engel II 级）。所有 7 名患者均患有导致 IM 的频繁癫痫发作：每天（5 名患者）或每周 1-2 次（2 名患者）。癫痫发作时的平均年龄（+/- 标准差，SD）为 1.6 +/- 1.3 岁（范围 0.5-4 岁）。病因包括结节性硬化症（3 名患者）、外伤（1 名患者）和未知（3 名患者）。手术时平均年龄 (+/- SD) 为 4.1 +/- 2 岁（范围 1-7 岁），癫痫持续时间为 2.5 +/- 1.1 年（范围 0.5-4 年）。 IM 的持续时间为 11.7 +/- 5.6 天（5-19 天）。六名患者使用双侧侵入式电极，一名患者使用单侧侵入式电极。在最后一次随访中，四名患者需要较少的抗癫痫药物 (AED)，一名患者服用相同的药物但剂量更高，两名患者服用额外的 AED。随访时间为 30.6 +/- 9.5 个月（范围 19-41 个月）。意义：虽然不常见，但 TRE 患者在单独 IM 后可能会有所改善。对这一观察结果的解释仍不清楚；然而，围手术期药物，包括类固醇、直接皮质操作或其他因素可能会影响致癫痫网络。
Purpose: Intracranial monitoring (IM) is a key diagnostic procedure for select patients with treatment-resistant epilepsy (TRE). Seizure focus resection may improve seizure control in both lesional and nonlesional TRE. IM itself is not considered to have therapeutic potential. We describe a cohort of patients with improved seizure control following IM without resective surgery.Methods: Over 12.5 years, 161 children underwent 496 surgeries including intracranial monitoring. We retrospectively reviewed the patients' charts, operative reports, and radiologic scans, under an institutional review board-approved protocol.Key Findings: Seventeen patients underwent only IM, without additional resective surgery, and seven had a dramatic improvement in their epilepsy; six of the seven patients are seizure-free (Engel class I), and one rarely has seizures (Engel class II). All seven patients had frequent seizures that led to IM: either daily (five patients) or 1-2 per week (two patients). The mean age (+/- standard deviation, SD) at seizure onset was 1.6 +/- 1.3 years (range 0.5-4 years). Etiologies were tuberous sclerosis (3 patients), trauma (1 patient), and unknown (3 patients). Mean age at surgery (+/- SD) was 4.1 +/- 2 years (range 1-7 years), and duration of epilepsy 2.5 +/- 1.1 years (range 0.5-4 years). Duration of IM was 11.7 +/- 5.6 days (5-19 days). Six patients had bilateral and one unilateral invasive electrodes. At last follow-up, four patients required fewer antiepileptic drugs (AEDs), one had the same medication but a higher dose, and two patients were taking additional AEDs. Follow-up was 30.6 +/- 9.5 months (range 19-41 months).Significance: Although uncommon, patients with TRE may improve after IM alone. The explanation for this observation remains unclear; however, perioperative medications including steroids, direct cortical manipulation, or other factors may influence the epileptogenic network.