EPILEPSY SURGERY IN CHILDREN WITH ELECTRICAL STATUS EPILEPTICUS IN SLEEP
EPILEPSY SURGERY IN CHILDREN WITH ELECTRICAL STATUS EPILEPTICUS IN SLEEP
复制标题
DOI：
10.1227/01.neu.0000336767.14252.76
复制
发表时间：
2009-02-01
期刊：
影响因子：
4.8
通讯作者：
Wyllie, Elaine
中科院分区：
文献类型：
--
作者：
Loddenkemper, Tobias;Cosmo, Gary;Wyllie, Elaine
目的：患有单侧先天性或早期获得性脑损伤的小儿癫痫手术候选者可能会出现难治性癫痫发作和广泛的脑电图特征，例如睡眠中癫痫电持续状态（ESES）。我们的研究目的是回顾一系列患有单侧脑部病变和 ESES 并接受难治性癫痫切除手术的儿童的临床表现、神经影像学结果和结果。方法：对在克利夫兰诊所接受视频脑电图评估和癫痫手术的 415 名连续 18 岁以下患者的 ESES、潜在病理病变和术后结果进行回顾。结果：纳入了 8 名患者。所有患者均出现难治性癫痫、偏瘫和发育迟缓。 7例为围产期梗死，1例为皮质发育畸形。术前脑电图显示所有病例均出现全身性发作间期尖峰、脑电图癫痫发作和 ESES。手术时的年龄为 3 至 14 岁。 6 名患者接受了半球切除术，2 名患者接受了局灶切除术。六名患者在切除后不再癫痫发作。两名接受功能性大脑半球切除术的患者仍出现罕见的癫痫发作，但情况已得到很大改善。这些患者在切除的对侧半球也有围产期梗塞，这可能表明预后较差。术后脑电图显示全身性发作间期放电和 ESES 全部消失。正式的术前和术后神经心理学测试显示年龄等效评分总体改善。结论：单侧脑损伤和癫痫发作的儿童在癫痫手术后可能会无癫痫发作，即使术前脑电图显示广泛性 ESES。生命早期发生的病变和病变位置可能在 ESES 的发展中发挥作用。 ESES 持续存在可能会加剧认知障碍。这个小样本的初步发育数据表明，通过癫痫手术终止癫痫发作以及可能的 ESES 可能具有发育益处。
OBJECTIVE: Pediatric epilepsy surgery candidates with unilateral congenital or early-acquired brain lesions may present with refractory seizures and generalized electroencephalographic features such as electrical status epilepticus in sleep (ESES). The purpose of our study was to review the clinical presentation, neuroimaging findings, and outcome in a series of children with unilateral brain lesions and ESES undergoing resective surgery for refractory epilepsy.METHODS: A total of 415 consecutive patients younger than 18 years of age undergoing video electroencephalographic evaluation and epilepsy surgery at Cleveland Clinic were reviewed for ESES, an underlying pathological lesion, and outcome after surgery.RESULTS: Eight patients were included. All patients presented with medically refractory epilepsy, hemiparesis, and developmental delay. The pathogenesis was perinatal infarction in 7 patients and malformation of cortical development in I patient. Preoperative electroencephalography demonstrated generalized interictal spikes, electroencephalographic seizures, and ESES in all cases. Age at the time of surgery ranged from 3 to 14 years. Six patients underwent hemispherectomy, and 2 patients underwent focal resection. Six patients became seizure-free after resection. Two patients with functional hemispherectomy continued to have rare seizures, but were much improved. These patients also had perinatal infarctions in the hemisphere contralateral to the resection, possibly indicating a less beneficial outcome. Postoperative electroencephalography demonstrated resolution of generalized interictal discharges and ESES in all. Formal pre- and postoperative neuropsychological testing showed overall improvement of age-equivalent scores.CONCLUSION: Children with unilateral brain lesions and seizures may become seizure-free after epilepsy surgery, even if the preoperative electroencephalogram shows generalized ESES. The lesion occurring early in life and the location of the lesion may play a role in the development of ESES. Cognitive impairment may be aggravated by the persistence of ESES. Preliminary developmental data in this small sample suggest that termination of seizures and possibly of ESES by epilepsy surgery may have developmental benefits.