Resective Pediatric Epilepsy Surgery in Lennox-Gastaut Syndrome
Resective Pediatric Epilepsy Surgery in Lennox-Gastaut Syndrome
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DOI：
10.1542/peds.2009-0566
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发表时间：
2010-01-01
期刊：
影响因子：
8
通讯作者：
Kim, Heung Dong
中科院分区：
文献类型：
--
作者：
Lee, Yun Jin;Kang, Hoon-Chul;Kim, Heung Dong
目的：本研究的目的是评估小儿癫痫切除手术对lenox - gastaut综合征（LGS）的作用。方法：我们分析了27例患有LGS的儿童和青少年的临床资料，这些儿童和青少年尽管有大量的全面性或全面性对侧最大和多区域脑电图异常（约占术前间歇期和/或癫痫样放电的30%），但仍接受了切除性癫痫手术。结果：高分辨率MRI显示，23例（85.2%）患者有脑损伤，4例（14.8%）患者未见脑损伤。患者手术时年龄在1.7 ~ 17.3岁之间（平均7.8岁）。手术为大叶或多叶切除21例（77.8%），半叶切除6例（22.2%）。术后平均随访33.1个月，16例（59.3%）患者无癫痫发作，4例（14.8%）患者少见癫痫发作。在4例MRI未发现脑异常的患者中，2例患者在电生理检查和其他多模态神经影像学结果一致的基础上，行切除手术后无癫痫发作。皮层发育畸形是最常见的病理，20例（74.1%）患者可见，但2例（7.4%）患者未表现出任何异常病理。16例（72.7%）患者出现发育商增高，其中14例术后无发作，2例术后不常发作。临床特征与术后无癫痫发作率无显著相关性。结论：尽管LGS患儿有大量的广泛性和多区域脑电图异常，但仍应考虑切除性癫痫手术。儿科2010;125: e58-e66
OBJECTIVE: The objective of this study was to evaluate the role of resective pediatric epilepsy surgery for Lennox-Gastaut syndrome (LGS).METHODS: We analyzed clinical data of 27 children and adolescents who had LGS and underwent resective epilepsy surgery despite abundant (>30% of preoperative interictal and/or ictal epileptiform discharges) generalized or generalized contralateral maximal and multiregional electroencephalogram abnormalities.RESULTS: On high-resolution MRI, cerebral lesions were noted in 23 (85.2%) patients but not in 4 (14.8%) patients. The age of patients at the time of surgery was between 1.7 and 17.3 years (mean: 7.8 years). Surgeries were lobar or multilobar resection in 21 (77.8%) patients and hemispherotomy in 6 (22.2%). At a mean of 33.1 months' postoperative follow-up, 16 (59.3%) patients had no seizures and 4 (14.8%) had infrequent seizures. Of 4 patients without brain abnormalities found on MRI, 2 patients became seizure-free after resective surgery was performed on the basis of electrophysiologic studies and concordant results in other multimodal neuroimages. Malformation of cortical development was the most common pathology and was seen in 20 (74.1%) patients, but 2 (7.4% patients) did not show any abnormal pathology. Sixteen (72.7%) patients, including 14 who had no seizures and 2 who had infrequent seizures after surgery, showed an increase in developmental quotient. No clinical profile was significantly associated with postoperative seizure-free rate.CONCLUSIONS: Resective epilepsy surgery should be considered for children with LGS, despite abundant generalized and multiregional electroencephalogram abnormalities. Pediatrics 2010; 125: e58-e66