Predictors of Seizure Outcome after Repeat Pediatric Epilepsy Surgery: Reasons for Failure, Sex, Electrophysiology, and Temporal Lobe Surgery.
Predictors of Seizure Outcome after Repeat Pediatric Epilepsy Surgery: Reasons for Failure, Sex, Electrophysiology, and Temporal Lobe Surgery.
复制标题
DOI：
10.2176/nmc.oa.2021-0315
复制
发表时间：
2022-03-15
影响因子：
1.9
通讯作者：
Kaneko Y
中科院分区：
文献类型：
--
作者：
Iwasaki M;Iijima K;Takayama Y;Kawashima T;Tachimori H;Kimura Y;Yokosako S;Kosugi K;Kaneko Y
考虑到无癫痫发作是癫痫治疗的最重要目标之一，对于癫痫手术后继续发生耐药性癫痫发作的患者，可以考虑再次癫痫手术。然而，据报告，癫痫手术失败后再次手术后无癫痫发作的机会低于50%。本研究旨在阐明小儿癫痫重复手术后癫痫发作结局的预测因素。回顾性研究了2008年至2020年期间在我们机构接受重复治疗性癫痫手术的39例儿科患者。对术前临床因素与术后末次随访时无癫痫发作之间的关系进行统计学评价。首次手术的平均年龄为5.5岁（0-16岁）。33例癫痫的病因为大脑皮质发育畸形。首次手术后癫痫复发的平均时间为6.4个月（范围，0-26个月）。共有16名患者（41.0%）在第二次手术后实现了癫痫发作。7例患者接受了第三次手术，3例（42.9%）实现了无癫痫发作。总体而言，19名患者在重复癫痫手术后实现了癫痫发作的自由（48.7%）。多变量分析表明，女性、由于技术限制导致的手术失败、一致的脑电图（EEG）结果、病灶磁共振成像（MRI）和右侧手术可预测无癫痫发作，而仅限于颞叶的手术可预测残留癫痫发作。癫痫手术失败的再手术具有挑战性。考虑上述预测因素有助于决定是否对初次手术干预失败的儿科患者进行再次手术。
Considering that seizure freedom is one of the most important goals in the treatment of epilepsy, repeat epilepsy surgery could be considered for patients who continue to experience drug-resistant seizures after epilepsy surgery. However, the chance of seizure freedom is reported to be below 50% after reoperation for failed epilepsy surgery. This study aimed to elucidate the predictive factors for seizure outcomes after repeat pediatric epilepsy surgery. In all, 39 pediatric patients who underwent repeat curative epilepsy surgery between 2008 and 2020 at our institution were retrospectively studied. The relationship between preoperative clinical factors and postoperative seizure freedom at the last follow-up was statistically evaluated. The mean age at the first surgery was 5.5 years (0–16). The etiology of epilepsy was malformation of cortical development in 33 patients. The average time to seizure recurrence after the first surgery was 6.4 months (range, 0–26 months). In all, 16 patients (41.0%) achieved seizure freedom after the second surgery. Seven patients underwent a third surgery, and three (42.9%) achieved seizure freedom. Overall, 19 patients achieved seizure freedom after repeat epilepsy surgery (48.7%). Female sex, surgical failure due to technical limitations, congruent electroencephalography (EEG) findings, lesional magnetic resonance imaging (MRI) and Rt-sided surgery were predictive of seizure freedom, and surgery limited to the temporal lobe was predictive of residual seizures, as determined in the multivariate analysis. The reoperation of failed epilepsy surgery is challenging. Consideration of the above predictive factors can be helpful in deciding whether to reoperate on pediatric patients whose initial surgical intervention failed.