Clinical features of patients with posterior cortex epilepsies and predictors of surgical outcome
Clinical features of patients with posterior cortex epilepsies and predictors of surgical outcome
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DOI：
10.1111/j.1528-1167.2005.70904.x
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发表时间：
2005-09-01
期刊：
影响因子：
5.6
通讯作者：
Sakamoto, AC
中科院分区：
文献类型：
--
作者：
Dalmagro, CL;Bianchin, MM;Sakamoto, AC
目的：后皮质癫痫（PCE）包括一组起源于颞叶枕叶、顶叶或枕叶边缘或这些区域的任何组合的癫痫。当他们的癫痫发作是难治性药物治疗，这些患者通常是指手术。我们的研究的目的是分析所有的PCE患者的临床特点，从1994年至2003年转介手术，并寻找手术outcome.Methods的预测因素：我们进行了回顾性分析的临床和实验室数据81连续难治性PCE患者转介手术。手术组和非手术组的患者进行了比较，并进行了详细的分析，所有变量的手术病例中进行了搜索的预测癫痫发作的结果。PCE的风险因素包括神经胶质增生（34.56%），皮质发育畸形肿瘤占33.33%（8.64%），脑外伤（3.70%），Sturge-Weber病癫痫家族史（3.70%）、中枢神经系统感染史（2.46%）、低智商（2.46%）。在81例患者中，44例在本研究完成时接受了手术。与以前单独的药物治疗相比，手术治疗在改善癫痫发作方面非常有效（p < 0.001）。28例（65.11%）患者在手术后癫痫发作消失，而非手术组无一例。关于预后预测因素，癫痫持续时间较短的患者和临床检查无神经系统异常的患者有更高的机会有利evolution.Conclusions：手术治疗是有效的治疗PCE和上级单独的药物治疗。在我们的系列研究中，癫痫持续时间短和神经系统检查正常是预测手术效果较好的唯一独立变量。
Purpose: Posterior cortex epilepsies (PCEs) encompass a group of epilepsies originating from the occipital, parietal, or occipital border of the temporal lobe, or from any combination of these regions. When their seizures are refractory to pharmacologic treatment, these patients are usually referred for surgery. The aim of our study was to analyze clinical characteristics of all PCE patients referred for surgery from 1994 to 2003, and to search for predictors of surgical outcome.Methods: We performed a retrospective analysis of clinical and laboratory data from 81 consecutive refractory PCE patients referred for surgery. Surgical and nonsurgical groups of patients were compared, and detailed analyses of all variables of the surgical cases were performed in the search for predictors of seizure outcome.Results: Risk factors for PCEs included gliosis (34.56%), malformations of cortical development (33.33%), tumors (8.64%), brain trauma (3.70%), Sturge-Weber disease (4.93%), vascular malformations (3.70%), family history of epilepsy (3.70%), history of CNS infections (2.46%), and low IQ (2.46%). Of the 81 patients, 44 were submitted to surgery at the time of the completion of this study. Surgical treatment was highly effective in improving seizures (p < 0.001) when compared with previous pharmacologic treatment alone. Twenty-eight (65.11%) patients became seizure free after surgery versus none in the nonsurgical group. Regarding outcome predictors, patients with shorter duration of epilepsy and those without neurologic abnormalities on clinical examination had higher chances of favorable evolution.Conclusions: Surgical treatment is effective for the treatment of PCEs and superior to pharmacologic therapy alone. In our series, shorter duration of epilepsy and normal neurologic examination were the only independent variables that predicted better surgical outcome.