Long-term seizure outcome and risk factors for recurrence after extratemporal epilepsy surgery
Long-term seizure outcome and risk factors for recurrence after extratemporal epilepsy surgery
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DOI：
10.1111/j.1528-1167.2012.03430.x
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发表时间：
2012-06-01
期刊：
影响因子：
5.6
通讯作者：
Berkovic, Samuel F.
中科院分区：
文献类型：
--
作者：
McIntosh, Anne M.;Averill, Clare A.;Berkovic, Samuel F.
目的：我们的目的是评估一组接受颞外切除术治疗难治性癫痫发作的患者的长期癫痫发作结局和癫痫复发的风险因素。方法：81例患者在澳大利亚墨尔本的Austin Health接受了颞外切除术（1991 - 2004）。癫痫复发是指任何术后致残性癫痫发作（复杂部分性癫痫发作[CPS] +/-继发性全身性发作）。多变量考克斯比例风险回归模型检查了潜在的术前和围手术期风险因素以及与术后早期癫痫发作（术后≥ 28天）相关的风险。同时测量术前和术后癫痫发作频率的变化。关键发现：中位随访时间为10.3年（范围117.7年）。术后1个月、1年和5年时无致残性癫痫发作（使用或停用抗癫痫药物）的概率分别为40.7%（95%置信区间[CI] 3051）、23.5%（95% CI 1533）和14.7%（95% CI 823）。57%的患者在术后5年时将致残性癫痫发作频率降低至术前的至少20%。在术前/围手术期因素中，局灶性皮质发育不良（FCD）1型（风险比[HR] 1.90，95% CI 1.083.34，p = 0.025）和切除不全（HR 1.71，95% CI 1.062.76，p = 0.028）是独立的复发风险。术后，术后早期癫痫发作是与较高风险相关的唯一因素（HR 4.28 [2.427.57]，p = 0.00）。重要性：区分局灶性皮质发育不良的亚型，可以使用磁共振成像（MRI）标准，可能是有用的术前诊断。手术后早期癫痫发作不是良性的，可能是导致癫痫复发的因素的标志。大多数患者癫痫发作频率大幅降低。需要进一步研究这种减少在手术成功或其他方面的意义。
Purpose: We aimed to assess long-term seizure outcome and risk factors for seizure recurrence in a cohort of patients who have undergone extratemporal resection for management of refractory seizures. Methods: Eighty-one patients underwent extratemporal resection at Austin Health, Melbourne, Australia (19912004). Seizure recurrence was any postoperative disabling seizure (complex partial seizure [CPS] +/- secondary generalization). Multivariate Cox proportional hazards regression models examined potential preoperative and perioperative risk factors and the risk associated with early postoperative seizures (=28 days postsurgery). The change between preoperative and postoperative seizure frequency was also measured. Key Findings: Median follow-up was 10.3 years (range 117.7). The probabilities of freedom from disabling seizures (on or off antiepileptic medication) were 40.7% (95% confidence interval [CI] 3051) at 1 month, 23.5% (95% CI 1533) at 1 year, and 14.7% (95% CI 823) at 5 years postoperative. Reduction of disabling seizures to at least 20% of preoperative frequency was attained by 57% of patients at 5 postoperative years. Of the preoperative/perioperative factors, focal cortical dysplasia (FCD) type 1 (hazard ratio [HR] 1.90, 95% CI 1.083.34, p = 0.025) and incomplete resection (HR 1.71, 95% CI 1.062.76, p = 0.028) were independent recurrence risks. After surgery, an early postoperative seizure was the only factor associated with higher risk (HR 4.28 [2.427.57], p = 0.00). Significance: Distinction between subtypes of focal cortical dysplasia, which can be made using magnetic resonance imaging (MRI) criteria, may be useful for preoperative prognostication. Early seizures after surgery are not benign and may be markers of factors that contribute to seizure recurrence. Most patients achieve substantial reduction in seizure frequency. Further study of the significance of this reduction in terms of surgical success or otherwise is required.