Pediatric refractory epilepsy: A decision analysis comparing medical versus surgical treatment.
Pediatric refractory epilepsy: A decision analysis comparing medical versus surgical treatment.
复制标题
小儿难治性癫痫：比较药物治疗与手术治疗的决策分析。
DOI：
10.1111/epi.12908
复制
发表时间：
2015
期刊：
影响因子：
5.6
通讯作者：
Loddenkemper,Tobias
中科院分区：
文献类型：
--
作者：
SánchezFernández,Iván;An,Sookee;Loddenkemper,Tobias
ObjectivesTo量化两种治疗策略：药物治疗与癫痫surgery.MethodsDecision analysis model populated with available parameters from the literature. ObjectivesTo quantify the life expectancy of surgical eligible children with refractory epilepsy comparing two treatment strategies：medical treatment only versus epilepsy surgery.MethodsDecision analysis model.单向和双向敏感性分析以及二阶蒙特卡罗模拟评估了结果在输入参数的广泛变化范围内的稳健性。的时间范围是终身和主要成果是life expectancy.ResultsAcross范围的儿科年龄，癫痫手术产生了较高的预期寿命。对于一个10岁难治性癫痫儿童队列，癫痫手术的预期寿命增加（与仅药物治疗相比）为颞叶癫痫5.9年，颞外癫痫5.6年。单向和双向灵敏度分析以及二阶蒙特卡罗模拟证明了结果在输入参数变化范围内的稳健性。没有对生活质量进行调整，但我们估计了无癫痫发作的预期寿命百分比。对于10岁难治性癫痫患者队列：（1）在颞叶癫痫中，癫痫手术获得了48.9%的无癫痫发作预期寿命，而药物治疗获得了14.3%;（2）颞外癫痫，癫痫手术治疗的无癫痫发作预期寿命为43.0%，药物治疗的无癫痫发作预期寿命为14.3%，对于符合手术条件的难治性癫痫儿童，癫痫手术比持续药物治疗的预期寿命要高得多。这一结论在广泛的参数变化范围内保持稳健。
ObjectivesTo quantify the life expectancy of surgically eligible children with refractory epilepsy comparing two treatment strategies: medical treatment only versus epilepsy surgery.MethodsDecision analysis model populated with available parameters from the literature. One‐ and two‐way sensitivity analyses and second‐order Monte Carlo simulations evaluated the robustness of the results across wide variations of the input parameters. The time horizon was lifetime and the main outcome was life expectancy.ResultsAcross the range of pediatric ages, epilepsy surgery yielded a higher life expectancy. For a cohort of 10‐year‐old children with refractory epilepsy, the gain in life expectancy with epilepsy surgery (compared to medical treatment only) was 5.9 years for temporal epilepsy and 5.6 years for extratemporal epilepsy. One‐ and two‐way sensitivity analyses and second‐order Monte Carlo simulations demonstrated the robustness of results across a wide variation of input parameters. There was no adjustment for quality of life, but we estimated the percentage of life expectancy spent in seizure freedom. For a cohort of 10‐year‐old patients with refractory epilepsy: (1) in temporal lobe epilepsy, epilepsy surgery yielded 48.9% of life expectancy years in seizure freedom while medical treatment yielded 14.3%; and (2) in extratemporal epilepsy, epilepsy surgery yielded 43.0% of life expectancy years in seizure freedom while medical treatment yielded 14.3%.SignificanceEpilepsy surgery yields a substantially higher life expectancy than continued medical treatment for surgically eligible children with refractory epilepsy. This conclusion remains robust across a wide range of parameter variations.