Long-term outcomes of resective epilepsy surgery after invasive presurgical evaluation in children with tuberous sclerosis complex and bilateral multiple lesions
Long-term outcomes of resective epilepsy surgery after invasive presurgical evaluation in children with tuberous sclerosis complex and bilateral multiple lesions
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DOI：
10.3171/2014.10.peds14107
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发表时间：
2015-01-01
影响因子：
1.9
通讯作者：
Mangano, Francesco T.
中科院分区：
文献类型：
--
作者：
Arya, Ravindra;Tenney, Jeffrey R.;Mangano, Francesco T.
对象 结节性硬化症 (TSC) 合并难治性癫痫的特点是多灶性脑部异常，传统上表明不适合手术。这项单中心回顾性研究评估了难治性癫痫 TSC 患者的癫痫相关、神经心理和切除手术的其他结果，并分析了这些结果的预测因素。 方法 从电子数据库中识别出 2007 年至 2012 年间接受癫痫手术的多病灶 TSC 患者。所有患者均接受多模式无创评估和随后的有创评估。使用国际抗癫痫联盟（ILAE）量表对癫痫发作结果进行分类。主要结果指标是癫痫发作完全缓解（ILAE 1 级）。次要结果指标包括 50% 的应答率、全量程智商变化、脑电图改善和抗癫痫药物 (AED) 负担减少。 结果 在研究期间，共有 37 名 TSC 患者接受了切除手术。时期。经过平均 5.68 +/- 3.67 年的随访后，56.8% 的患者完全无癫痫发作（ILAE 1 级），86.5% 的患者达到 ILAE 4 级或更好的结果。与 ILAE 2 级或更差结果的患者 (56.00 +/- 1.41，p = 0.025) 相比，ILAE 1 级结果的患者 (66.70 +/- 12.36) 随访时的全面智商显着更高。在 62.5% 的 ILAE 2 级或更差结果的患者中，AED 的数量显着减少 (p = 0.004)。 结论 这项研究证实了癫痫切除手术对双侧多病灶 TSC 患者的疗效证据。超过一半的患者完全没有癫痫发作。此外，很大一部分人实现了具有临床意义的癫痫发作负担和 AED 数量的减少。
OBJECT Tuberous sclerosis complex (TSC) with medically refractory epilepsy is characterized by multifocal brain abnormalities, traditionally indicating poor surgical candidacy. This single-center, retrospective study appraised seizure-related, neuropsychological, and other outcomes of resective surgery in TSC patients with medically refractory epilepsy, and analyzed predictors for these outcomes.METHODS Patients with multilesional TSC who underwent epilepsy surgery between 2007 and 2012 were identified from an electronic database. All patients underwent multimodality noninvasive and subsequent invasive evaluation. Seizure outcomes were classified using the International League Against Epilepsy (ILAE) scale. The primary outcome measure was complete seizure remission (ILAE Class 1). Secondary outcome measures included 50% responder rate, change in full-scale IQ, electroencephalography improvement, and reduction in antiepileptic drug (AED) burden.RESULTS A total of 37 patients with TSC underwent resective surgery during the study. period. After a mean follow-up of 5.68 +/- 3.67 years, 56.8% achieved complete seizure freedom (ILAE Class 1) and 86.5% had ILAE Class 4 outcomes or better. The full-scale IQ on follow-up was significantly higher in patients with ILAE Class 1 outcome (66.70 +/- 12.36) compared with those with ILAE Class 2 or worse outcomes (56.00 +/- 1.41, p = 0.025). In 62.5% of the patients with ILAE Class 2 or worse outcomes, the number of AEDs were found to be significantly reduced (p = 0.004).CONCLUSIONS This study substantiates the evidence for efficacy of resective epilepsy surgery in patients with bilateral multilesional TSC. More than half of the patients were completely seizure free. Additionally, a high proportion achieved clinically meaningful reduction in seizure burden and the number of AEDs.