Outcomes of tumour related epilepsy in a specialised epilepsy surgery unit
Outcomes of tumour related epilepsy in a specialised epilepsy surgery unit
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DOI：
10.1016/j.jocn.2018.01.062
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发表时间：
2019-01-01
影响因子：
2
通讯作者：
Dexter, M. A.
中科院分区：
文献类型：
--
作者：
Kim, J.;Radjadurai, S.;Dexter, M. A.
引言：癫痫发作是低级别胶质瘤患者发病的重要原因，约40%的病例具有耐药性。其发病机制相当复杂，且知之甚少。治疗目标在几乎纯粹的癫痫考虑和那些主要是肿瘤学的考虑之间变化。目的：确定与普通神经外科服务相比，通过专门的癫痫单位管理时，出现癫痫发作并被发现具有低级别胶质瘤的患者是否具有更好的结果。方法：对前瞻性收集的数据库进行了为期10年的审查，以确定48名出现癫痫发作并随后发现患有低级别胶质瘤的成年患者。通过专门的癫痫服务或一般神经外科服务，这些患者进行了分析管理。主要结局是两组之间的Engel分级。次要结局包括复发、术后功能障碍、手术延迟、组织学、分级和切除范围。结局：与普通神经外科服务相比，通过癫痫服务管理的患者具有显著更高的有利恩格尔结局（I和II）率（OR：13.2，95%CI：1.239-140.679：P = 0.033）。癫痫手术组患者手术延迟率明显高于对照组（P < 0.001）。癫痫服务的患者切除率显著高于普通神经外科服务（73% vs 127%，P = 0.014）。两组之间的复发率无差异。结论：肿瘤相关癫痫患者进行了密集的术前评估，可能会获得更好的癫痫发作相关的结果。(C)2018爱思唯尔有限公司版权所有
Introduction: Seizures are an important cause of morbidity in patients with low grade gliomas with approximately 40% of cases drug resistant. The pathogenesis is quite complex and poorly understood. The treatment aims vary between almost purely epilepsy considerations and those that are primarily oncologic.Aim: To determine whether patients who present with seizures and are found to have a low grade glioma have better outcomes when managed through a specialized epilepsy unit compared to the general neurosurgical service.Methods: A review of the prospectively collected database was performed over a 10 year period to identify 48 adult patients who present with a seizure and were subsequently found to have a low grade glioma. These patients were analysed with respect to management through the specialized epilepsy service or the general neurosurgical service. The primary outcome was Engel classification between the two groups. Secondary outcomes included recurrence, postoperative deficits, delay to surgery, histology, grade and extent of resection.Outcomes: The patients managed through the epilepsy service had significantly higher rate of favourable Engel outcomes (I and II) compared to the general neurosurgery service (OR: 13.2, 95% CI: 1.239-140.679: P = 0.033). The epilepsy surgery group patients had a significantly higher delay to surgery (P < 0.001). The patients in the epilepsy service had a significantly higher resection ratio compared to the general neurosurgery service (73% vs 127%, P = 0.014). Rates of recurrence were not different between the two groups.Conclusion: Patients with tumour related epilepsy who undergo an intensive presurgical evaluation may obtain better seizure related outcomes. (C) 2018 Elsevier Ltd. All rights reserved.