Improved outcomes in pediatric epilepsy surgery The UCLA experience, 1986-2008
Improved outcomes in pediatric epilepsy surgery The UCLA experience, 1986-2008
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DOI：
10.1212/wnl.0b013e3181e0f17a
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发表时间：
2010-06-01
期刊：
影响因子：
9.9
通讯作者：
Mathern, G. W.
中科院分区：
文献类型：
--
作者：
Hemb, M.;Velasco, T. R.;Mathern, G. W.
目的：癫痫神经外科手术是儿童顽固性癫痫的一种治疗选择。我们的目的是确定结果是否随着时间的推移而改善。方法：比较前11年（1986-1997年，1997年以前）小儿癫痫手术患者与后11年（1998-2008年，1997年以后）患儿术前、术后变量的差异。结果：尽管在癫痫发作频率、发病年龄和手术年龄上有相似之处，1997年后的研究与1997年前的研究相比，有更多的大叶/局灶性切除和更少的多叶切除，更多的结节性硬化症患者和更少的非特异性胶质瘤病例。1997年后进行颅内脑电图检查的病例（0.8%）比1997年前组（9%）少。与1997年前组相比，1997年后组无癫痫发作的患者较多，分别为0.5年（83%,+16%）、1年（81%,+18%）、2年（77%,+19%）和5年（74%,+29%）；无癫痫发作的患者在手术后0.5年（97%,+6%）、1年（88%,+9%）和2年（76%,+29%）服药，但5年（64%,+8%）服药的患者较少。与1997年前组相比，1997年后组的并发症和再手术较少。Logistic回归确定1997年后系列和较少积极的药物停药是术后2年无癫痫发作的主要预测因素。结论：改进的技术和外科手术以及临床实践的变化可能与1997年后系列中增强和持续的无癫痫发作结果相关。这些发现支持了一个普遍的概念，即更清晰地识别病变和完全切除与儿童癫痫手术患者更好的预后有关。神经病学(R) 2010;74:1768 - 1775
Objective: Epilepsy neurosurgery is a treatment option for children with refractory epilepsy. Our aim was to determine if outcomes improved over time.Methods: Pediatric epilepsy surgery patients operated in the first 11 years (1986-1997; pre-1997) were compared with the second 11 years (1998-2008; post-1997) for differences in presurgical and postsurgical variables.Results: Despite similarities in seizure frequency, age at seizure onset, and age at surgery, the post-1997 series had more lobar/focal and fewer multilobar resections, and more patients with tuberous sclerosis complex and fewer cases of nonspecific gliosis compared with the pre-1997 group. Fewer cases had intracranial EEG studies in the post-1997 (0.8%) compared with the pre-1997 group (9%). Compared with the pre-1997 group, the post-1997 series had more seizure-free patients at 0.5 (83%, +16%), 1 (81%, +18%), 2 (77%, +19%), and 5 (74%, +29%) years, and more seizure-free patients were on medications at 0.5 (97%, +6%), 1 (88%, +9%), and 2 (76%, +29%), but not 5 (64%, +8%) years after surgery. There were fewer complications and reoperations in the post-1997 series compared with the pre-1997 group. Logistic regression identified post-1997 series and less aggressive medication withdrawal as the main predictors of becoming seizure-free 2 years after surgery.Conclusions: Improved technology and surgical procedures along with changes in clinical practice were likely factors linked with enhanced and sustained seizure-free outcomes in the post-1997 series. These findings support the general concept that clearer identification of lesions and complete resection are linked with better outcomes in pediatric epilepsy surgery patients. Neurology(R) 2010;74:1768-1775