Beyond seizure freedom: Dissecting long-term seizure control after surgical resection for drug-resistant epilepsy.
Beyond seizure freedom: Dissecting long-term seizure control after surgical resection for drug-resistant epilepsy.
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DOI：
10.1111/epi.17445
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发表时间：
2023-01
期刊：
影响因子：
5.6
通讯作者：
Jehi, Lara
中科院分区：
文献类型：
--
作者：
Hsieh, Jason K.;Pucci, Francesco G.;Sundar, Swetha J.;Kondylis, Efstathios;Sharma, Akshay;Sheikh, Shehryar R.;Vegh, Deborah;Moosa, Ahsan N.;Gupta, Ajay;Najm, Imad;Rammo, Richard;Bingaman, William;Jehi, Lara
这项研究是为了更好地了解手术切除对难治性癫痫患者的长期姑息和疾病改善作用，包括减少发作频率和晚期复发和缓解。这项由数据库驱动的回溯性队列研究包括了所有在一个大容量癫痫中心进行了9年 随访的患者。我们纳入了接受肺叶切除术、多叶切除术或因耐药癫痫而行病变切除术的患者；我们排除了接受半球切除术的患者。我们的主要结果是(1)致残性癫痫发作的频率减少(术后6个月，每年最多9 年，最后一次随访)，(2)癫痫发作缓解(6个月，一年，持续时间最长)，以及(3)最后一次随访时癫痫发作缓解。251例患者中，234例(93.2%)发作缓解6个月，232例(92.4%)发作缓解1年。其中，癫痫发作自由期平均为10.3 年。总共有182名患者(72.5%)在最后一次随访(定义为1年内没有癫痫发作)时无癫痫发作，缓解后的中位数为11.9 年。未完全缓解者，各时点发作频率平均减少76.2%，最低为66.6%，最低为85.0%。患者平均减少了0.58次抗癫痫药物，53名患者(21.2%)在最后一次随访时没有服用抗癫痫药物。在最后一次随访中，近一半(47.1%)的患者术后即刻不能完全消除癫痫。切除后仍有癫痫发作的患者，癫痫发作频率往往有相当大的降低，许多患者能够以延迟的方式实现癫痫发作的自由。
This study was undertaken to better understand the long‐term palliative and disease‐modifying effects of surgical resection beyond seizure freedom, including frequency reduction and both late recurrence and remission, in patients with drug‐resistant epilepsy. This retrospective database‐driven cohort study included all patients with >9 years of follow‐up at a single high‐volume epilepsy center. We included patients who underwent lobectomy, multilobar resection, or lesionectomies for drug‐resistant epilepsy; we excluded patients who underwent hemispherectomies. Our main outcomes were (1) reduction in frequency of disabling seizures (at 6 months, each year up to 9 years postoperatively, and at last follow‐up), (2) achievement of seizure remission (>6 months, >1 year, and longest duration), and (3) seizure freedom at last follow‐up. We included 251 patients; 234 (93.2%) achieved 6 months and 232 (92.4%) experienced 1 year of seizure freedom. Of these, the average period of seizure freedom was 10.3 years. A total of 182 (72.5%) patients were seizure‐free at last follow‐up (defined as >1 year without seizures), with a median 11.9 years since remission. For patients not completely seizure‐free, the mean seizure frequency reduction at each time point was 76.2%, and ranged from 66.6% to 85.0%. Patients decreased their number of antiseizure medications on average by .58, and 53 (21.2%) patients were on no antiseizure medication at last follow‐up. Nearly half (47.1%) of those seizure‐free at last follow‐up were not seizure‐free immediately postoperatively. Patients who continue to have seizures after resection often have considerable reductions in seizure frequency, and many are able to achieve seizure freedom in a delayed manner.
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