Yasuda Clarissa L, Tedeschi Helder, Oliveira Evandro L P, Ribas Guilherme C, Costa Alberto L C, Cardoso Tânia A M O, Montenegro Maria A, Guerreiro Carlos A M, Guerreiro Marilisa M, Li Li M, Cendes Fernando
Department of Neurology, State University of Campinas, Campinas, SP 13083-970, Brazil.
Seizure. 2006 Jan;15(1):35-40. doi: 10.1016/j.seizure.2005.10.005. Epub 2005 Dec 5.
To compare the efficacy of medical and surgical treatment for refractory mesial temporal lobe epilepsy associated with hippocampal sclerosis (MTLE).
A prospective controlled non-randomized study of 26 patients with MTLE who underwent surgical treatment and 75 patients with MTLE who underwent medical treatment between August 2002 and October 2004. All patients failed to achieve seizure control with at least two first line antiepileptic drugs (AED) for partial seizures before entering the study. We used Kaplan-Meier survival analyses as a function of time of seizure recurrence to obtain estimates of 95% confident interval of seizure freedom and log-rank test to compare the status of seizure control between the two groups.
The cumulative proportion of patients free of all seizures (Engel's class IA) was higher in the surgical group (73%) compared to the clinical group (12%) (p<0.0001). In the surgical group, 2 of 26 patients (7.7%) had transient adverse effects and 2 of 26 patients (7.7%) had a permanent deficit related to the surgical procedure. In the clinical group 7 patients (9.3%) major adverse events during follow-up, including burns and status epilepticus.
Surgical treatment for patients with MTLE who failed to achieve seizure control with two previous AED regimens was more efficient than medical treatment with further trials of AED.
比较药物治疗与手术治疗对难治性内侧颞叶癫痫伴海马硬化（MTLE）的疗效。
对2002年8月至2004年10月间26例行手术治疗的MTLE患者和75例行药物治疗的MTLE患者进行前瞻性对照非随机研究。所有患者在进入研究前至少使用两种一线抗癫痫药物（AED）治疗部分性癫痫发作但未达到癫痫控制。我们使用Kaplan-Meier生存分析作为癫痫复发时间的函数，以获得无癫痫发作的95%置信区间估计，并使用对数秩检验比较两组的癫痫控制状况。
手术组无癫痫发作（Engel I A级）的患者累积比例（73%）高于药物治疗组（12%）（p<0.0001）。手术组中，26例患者中有2例（7.7%）出现短暂不良反应，26例患者中有2例（7.7%）出现与手术相关的永久性神经功能缺损。药物治疗组7例患者（9.3%）在随访期间出现严重不良事件，包括烧伤和癫痫持续状态。
对于使用两种先前AED方案未能控制癫痫发作的MTLE患者，手术治疗比进一步试用AED的药物治疗更有效。
