Maehara T, Shimizu H
Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, Japan.
Epilepsia. 2001 Jan;42(1):67-71. doi: 10.1046/j.1528-1157.2001.081422.x.
We examined presurgical factors that independently influence surgical outcome after corpus callosotomy. For adequate measurement of the surgical outcome, we analyzed seizure outcome of drop attacks, postoperative overall daily function, and family satisfaction.
At least 2 years after callosotomy (mean, 40.0 months), we retrospectively investigated 52 patients with drop attacks. As presurgical factors, we analyzed the age at surgery, age at seizure onset, age at drop attack onset, sex, hemiparesis, severe mental retardation, EEG abnormality, MRI abnormality, and extent of callosal section (total or partial callosotomy). Stepwise logistic regression was used for analysis.
Satisfactory outcome (seizure cessation or >90% seizure reduction) was achieved in 85% of patients with drop attacks, 32% of those with generalized tonic seizures, and 31% of those with generalized tonic-clonic seizures. The families assessed the overall daily function as improved in 62% of patients, unchanged in 23%, and impaired in 15%. Family satisfaction with callosotomy was achieved in 83% of patients (definitely satisfied, 39%, somewhat satisfied, 44%). Total callosotomy is independently predictive of satisfactory reduction of drop attacks (p = 0.013). A younger age is independently predictive of improvement of overall daily function (impaired and improved: p = 0.004) and family satisfaction (unsatisfied and somewhat satisfied, p = 0.018; unsatisfied and definitely satisfied, p = 0.0006).
In the present study, we found that total callosotomy is more effective for treatment of drop attacks than partial callosotomy and that children receive more benefit than adults after callosotomy.
我们研究了独立影响胼胝体切开术后手术结果的术前因素。为了充分衡量手术结果，我们分析了跌倒发作的癫痫发作结果、术后总体日常功能以及家属满意度。
在胼胝体切开术后至少2年（平均40.0个月），我们对52例有跌倒发作的患者进行了回顾性研究。作为术前因素，我们分析了手术年龄、癫痫发作起始年龄、跌倒发作起始年龄、性别、偏瘫、重度智力发育迟缓、脑电图异常、磁共振成像异常以及胼胝体切开范围（完全或部分胼胝体切开术）。采用逐步逻辑回归进行分析。
85%有跌倒发作的患者、32%有全身强直发作的患者以及31%有全身强直阵挛发作的患者取得了满意的结果（癫痫发作停止或癫痫发作减少>90%）。家属评估62%的患者总体日常功能有所改善，23%未变，15%受损。83%的患者家属对胼胝体切开术感到满意（非常满意，39%；有点满意，44%）。完全胼胝体切开术可独立预测跌倒发作得到满意缓解（p = 0.013）。年龄较小可独立预测总体日常功能改善（受损与改善：p = 0.004）以及家属满意度（不满意与有点满意，p = 0.018；不满意与非常满意，p = 0.0006）。
在本研究中，我们发现完全胼胝体切开术治疗跌倒发作比部分胼胝体切开术更有效，并且儿童在胼胝体切开术后比成人受益更多。
