Bjørnaes Helge, Stabell Kirsten Engberg, Heminghyt Einar, Røste Geir Ketil, Bakke Søren Jacob
The National Centre for Epilepsy, Sandvika, Norway.
Epilepsia. 2004 Feb;45(2):131-9. doi: 10.1111/j.0013-9580.2004.34003.x.
To investigate possible predictive factors for seizure control in a group of children and adults with low IQs (IQ, < or =70) who underwent resective surgery for intractable focal epilepsy and to study outcome with respect to seizures and neuropsychological functioning. We also studied psychosocial outcome in the adult patients.
Thirty-one patients (eight children younger than 18 years) with a Wechsler Full Scale IQ of 70 or less underwent comprehensive neuropsychological assessments before and 2 years after surgery. Adults also completed the Washington Psychosocial Seizure Inventory (WPSI). Univariate analyses were used to identify variables differentiating between patients who became seizure free and those who did not. Pre- and postoperative test results were compared by t test for dependent samples.
Forty-eight percent of the patients became seizure free, 52% of those with temporal lobe resection and 38% of those with extratemporal resection. Only one variable was predictive for seizure outcome: duration of epilepsy. In one third of the patients, who had the shortest duration of epilepsy (<12 years), 80% became seizure free. Significant improvement was seen regarding vocational adjustment in adults (WPSI). Seizure-free adults improved their Full Scale IQ scores. No cognitive changes were found in seizure-free children or in patients who did not become seizure free.
A good seizure outcome was obtained after resective surgery in patients with intractable focal epilepsy and low IQ, provided that treatment was done relatively shortly after onset of epilepsy. No adverse effects were seen on cognitive and psychosocial functioning.
研究一组接受难治性局灶性癫痫切除手术的低智商（智商≤70）儿童和成人癫痫控制的可能预测因素，并研究癫痫发作及神经心理功能方面的结果。我们还研究了成年患者的社会心理结果。
31例韦氏全量表智商为70或更低的患者（8例18岁以下儿童）在手术前和术后2年接受了全面的神经心理评估。成年患者还完成了华盛顿癫痫社会心理量表（WPSIPSI Inventory for Washington Psychosocial Seizure Inventory，WPSI）。采用单因素分析来确定区分癫痫发作缓解患者和未缓解患者的变量。通过配对t检验比较术前和术后的测试结果。
48%的患者癫痫发作得到缓解，颞叶切除患者中52%缓解，颞叶外切除患者中38%缓解。只有一个变量可预测癫痫发作结果：癫痫病程。癫痫病程最短（<12年）的患者中有三分之一，80%癫痫发作得到缓解。成年患者在职业适应方面有显著改善（WPSI）。癫痫发作缓解的成年患者全量表智商得分有所提高。癫痫发作缓解的儿童或未缓解的患者未发现认知变化。
对于难治性局灶性癫痫且智商较低的患者，在癫痫发作后相对较短时间内进行切除手术可获得良好的癫痫发作控制效果。未观察到对认知和社会心理功能的不良影响。
