Initial outcomes in the multicenter study of epilepsy surgery
Initial outcomes in the multicenter study of epilepsy surgery
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DOI：
10.1212/01.wnl.0000098937.35486.a3
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发表时间：
2003-12-23
期刊：
影响因子：
9.9
通讯作者：
Frobish, D
中科院分区：
文献类型：
--
作者：
Spencer, SS;Berg, AT;Frobish, D
目的：获得关于癫痫切除术后癫痫发作、焦虑、抑郁和生活质量（QOL）结局的前瞻性数据。研究方法：作者采用标准化的工具和患者访谈，前瞻性地以每年为间隔对切除性癫痫手术患者的癫痫发作结局、生活质量、焦虑和抑郁进行表征。结果：在396例接受切除手术的患者中，355例至少随访1年。其中，75%在随访期间的某个时间达到了1年缓解;内侧颞叶切除患者（77%）比新皮质切除患者（56%）更有可能达到缓解（p = 0.01）。复发发生在59例（22%）缓解的患者中，更常见于内侧颞叶（24%）比新皮质（4%）切除患者（p = 0.02）。术后3个月内，生活质量、焦虑和抑郁均显著改善（p < 0.0001），癫痫发作结局无显著差异。3个月后，无癫痫患者的生活质量进一步改善，癫痫患者的生活质量逐渐下降。到12个月和24个月时，两个结局组的总体QOL及其癫痫靶向和身体健康领域存在显著差异。（焦虑和抑郁评分也逐渐分化，无癫痫组有所改善，持续癫痫组有所下降，但差异不显著。结论：切除手术治疗癫痫可显著减少癫痫发作，与新皮质切除术（56% 1年缓解）相比，颞叶内侧切除术（77% 1年缓解）后癫痫发作最明显。切除性癫痫手术对生活质量有逐渐但持久的影响，但对焦虑和抑郁的影响很小。更长时间的随访对于确定癫痫手术的最终癫痫发作、生活质量和精神病学结局至关重要。
Objective: To obtain prospective data regarding seizures, anxiety, depression, and quality of life (QOL) outcomes after resective epilepsy surgery. Methods: The authors characterized resective epilepsy surgery patients prospectively at yearly intervals for seizure outcome, QOL, anxiety, and depression, using standardized instruments and patient interviews. Results: Of 396 patients who underwent resective surgical procedures, 355 were followed for at least 1 year. Of these, 75% achieved a 1-year remission at some time during follow-up; patients with medial temporal (77%) were more likely than neocortical resections (56%) to achieve remission (p = 0.01). Relapse occurred in 59 (22%) patients who remitted, more often in medial temporal (24%) than neocortical (4%) resected patients (p = 0.02). QOL, anxiety, and depression all improved dramatically within 3 months after surgery (p < 0.0001), with no significant difference based on seizure outcome. After 3 months, QOL in seizure-free patients further improved gradually, and patients with seizures showed gradual declines. By 12 and 24 months, overall QOL and its epilepsy-targeted and physical health domains were significantly different in the two outcome groups. (Anxiety and depression scores also gradually diverged, with improvements in seizure-free and declines in continued seizure groups, but differences were not significant.) Conclusion: Resective surgery for treatment of epilepsy significantly reduces seizures, most strikingly after medial temporal resection (77% 1 year remission) compared to neocortical resection (56% 1 year remission). Resective epilepsy surgery has a gradual but lasting effect on QOL, but minimal effects on anxiety and depression. Longer follow-up will be essential to determine ultimate seizure, QOL, and psychiatric outcomes of epilepsy surgery.