Rougier A, Dartigues J F, Commenges D, Claverie B, Loiseau P, Cohadon F
Department of Neurology, Hôpital Pellegrin, Bordeaux, France.
J Neurol Neurosurg Psychiatry. 1992 Sep;55(9):762-7. doi: 10.1136/jnnp.55.9.762.
Results of 100 cortical resections for 76 temporal, 23 frontal and one parietal lobe epilepsies were studied in terms of seizure relief and overall benefit. A non-homogenous Markov chain model was used to take into account both the intravariability of post-surgical outcome and the differences in duration of follow-up in a group of patients consecutively operated. The seizure free (SF) state was defined as no seizure in the previous five months at first follow up visit and none in the preceding 12 months at subsequent annual visits. For the whole of the population the SF probability was 82%, 66%, 61%, and 62% at six months, one year, two and five years respectively. A better outcome was found for temporal lobe epilepsy (SF probability: 68% at the fifth postoperative year) than for frontal lobe epilepsy (SF probability: 42% at the fifth postoperative year) with a statistically significant difference. Pre- and postoperative interictal signs and symptoms were classified according to their clinical significance: (a) mild handicap--symptoms recognisable but no interference with usual life, and (b) moderate or severe handicap--interference with some or all daily activities. The interictal state was considered more impaired after surgery than before in two situations: (a) either symptoms, absent before surgery, appeared in the postoperative period involving a moderate or severe handicap, or (b) symptoms present before surgery and answerable for a mild or moderate handicap that increased to involve a moderate or severe handicap respectively in the postoperative period. Surgery was considered a major benefit when two conditions were fulfilled-namely, a SF state and no deterioration of the interictal stage when compared with the preoperative period. The probability of obtaining such a benefit was 58%, 51%, 48% and 56% at six months, one year, two and five years respectively. The results suggest that surgery is an effective treatment for more than 50% of long lasting medically intractable epilepsies.
对因76例颞叶癫痫、23例额叶癫痫和1例顶叶癫痫而进行的100例皮质切除术的结果，从癫痫发作缓解情况和总体获益方面进行了研究。采用非齐次马尔可夫链模型，以考虑一组连续接受手术患者术后结果的内部变异性以及随访时间的差异。无癫痫发作（SF）状态定义为首次随访时前五个月无癫痫发作，随后年度随访时前十二个月无癫痫发作。对于全体患者，术后六个月、一年、两年和五年时的无癫痫发作概率分别为82%、66%、61%和62%。发现颞叶癫痫（术后第五年无癫痫发作概率：68%）的预后优于额叶癫痫（术后第五年无癫痫发作概率：42%），差异具有统计学意义。术前和术后的发作间期体征和症状根据其临床意义进行分类：（a）轻度障碍——症状可识别但不影响日常生活，（b）中度或重度障碍——影响部分或全部日常活动。在两种情况下，术后发作间期状态被认为比术前受损更严重：（a）术前不存在的症状在术后出现，涉及中度或重度障碍，或（b）术前存在的症状，对应轻度或中度障碍，在术后分别加重至涉及中度或重度障碍。当满足两个条件时，手术被认为具有重大益处，即无癫痫发作状态且与术前相比发作间期阶段无恶化。在术后六个月、一年、两年和五年时获得这种益处的概率分别为58%、51%、48%和56%。结果表明，手术是超过50%的长期药物难治性癫痫的有效治疗方法。
