Spencer S S, Berg A T, Vickrey B G, Sperling M R, Bazil C W, Shinnar S, Langfitt J T, Walczak T S, Pacia S V, Ebrahimi N, Frobish D
Department of Neurology, Yale University School of Medicine, New Haven, CT 06520-8018, USA.
Neurology. 2003 Dec 23;61(12):1680-5. doi: 10.1212/01.wnl.0000098937.35486.a3.
To obtain prospective data regarding seizures, anxiety, depression, and quality of life (QOL) outcomes after resective epilepsy surgery.
The authors characterized resective epilepsy surgery patients prospectively at yearly intervals for seizure outcome, QOL, anxiety, and depression, using standardized instruments and patient interviews.
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.)
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.
获取有关切除性癫痫手术后癫痫发作、焦虑、抑郁及生活质量（QOL）结果的前瞻性数据。
作者使用标准化工具和患者访谈，对切除性癫痫手术患者每年进行前瞻性评估，以了解癫痫发作结果、生活质量、焦虑和抑郁情况。
在396例行切除性手术的患者中，355例至少随访了1年。其中，75%在随访期间的某个时间达到了1年缓解；内侧颞叶患者（77%）比新皮质切除术患者（56%）更有可能达到缓解（p = 0.01）。59例（22%）缓解患者出现复发，内侧颞叶切除患者（24%）比新皮质切除患者（4%）更常复发（p = 0.02）。生活质量、焦虑和抑郁在术后3个月内均显著改善（p < 0.0001），基于癫痫发作结果无显著差异。3个月后，无癫痫发作患者的生活质量进一步逐渐改善，有癫痫发作的患者则逐渐下降。到12个月和24个月时，两个结果组的总体生活质量及其癫痫针对性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，无癫痫发作组有所改善，持续有癫痫发作组有所下降，但差异不显著。）
切除性手术治疗癫痫可显著减少癫痫发作，与新皮质切除术（1年缓解率56%）相比，内侧颞叶切除术后最为显著（1年缓解率77%）。切除性癫痫手术对生活质量有逐渐但持久的影响，但对焦虑和抑郁影响极小。更长时间的随访对于确定癫痫手术的最终癫痫发作、生活质量和精神结果至关重要。
