Van Oijen Marieke, De Waal Hanneke, Van Rijen Peter C, Jennekens-Schinkel Aag, van Huffelen Alexander C, Van Nieuwenhuizen Onno
Department of Child Neurology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
Eur J Paediatr Neurol. 2006 May;10(3):114-23. doi: 10.1016/j.ejpn.2006.04.003. Epub 2006 Jun 12.
We present the outcome of resective epilepsy surgery in 69 pediatric patients who participated in the Dutch Collaborative Epilepsy Surgery Program (DCESP) between 1992 and 2002 with special emphasis on long-term follow-up.
Sixty-nine children (aged 3 months to 17 years) operated on before 2003 were included in this study (34 temporal resections (49%), 17 extra-temporal resections (24%) and 19 hemispherectomies (27%)). Engel classification was used to assess seizure outcome annually. Cognitive outcome was assessed if possible. Two telephone surveys were carried out with an interval of 2(1/2) years to obtain data on seizure frequency, use of AEDs and on aspects op psychosocial development. Kaplan-Meier survival curves were constructed to assess recurrence of seizures after initial postsurgical seizure freedom, based on both telephone surveys.
Seventy percent scored Engel 1, 18% Engel 2, 6% Engel 3 and 6% Engel 4 at the time of the first telephone survey (2(1/2) years later: 77% Engel 1, 8% Engel 2, 12% Engel 3 and 3% Engel 4). Temporal resections were associated with the best seizure outcome (Engel 1 74% and 82%). AEDs could be withdrawn successfully in 53% of patients at time of the last follow-up. No negative impact on cognition was found. The first long-term follow-up (mean 4.5 years after surgery) measurement showed recurrence of seizures after initial seizure freedom in 17%. At time of the second long-term follow-up measurement (mean 7.5 years after surgery) this percentage had increased to 21%.
Our results support previous reports that surgery for intractable epilepsy in pediatric patients can be safely performed with satisfactory long-term results. Best results are attained in temporal resections.
我们展示了1992年至2002年间参与荷兰癫痫手术协作项目（DCESP）的69例儿科患者的切除性癫痫手术结果，特别强调长期随访。
本研究纳入了2003年前接受手术的69名儿童（年龄3个月至17岁）（34例颞叶切除术（49%），17例颞叶外切除术（24%）和19例大脑半球切除术（27%））。每年使用恩格尔分类法评估癫痫发作结果。尽可能评估认知结果。进行了两次间隔2.5年的电话调查，以获取癫痫发作频率、抗癫痫药物使用情况以及心理社会发展方面的数据。基于两次电话调查构建了Kaplan-Meier生存曲线，以评估术后首次无癫痫发作后癫痫复发情况。
在第一次电话调查时，70%的患者恩格尔分级为1级，18%为2级，6%为3级，6%为4级（2.5年后：77%为恩格尔1级，8%为2级，12%为3级，3%为4级）。颞叶切除术的癫痫发作结果最佳（恩格尔1级分别为74%和82%）。在最后一次随访时，53%的患者成功停用了抗癫痫药物。未发现对认知有负面影响。首次长期随访（术后平均4.5年）测量显示，17%的患者在首次无癫痫发作后癫痫复发。在第二次长期随访测量时（术后平均7.5年），这一比例增至21%。
我们的结果支持先前的报告，即儿科患者的难治性癫痫手术可以安全进行，并取得令人满意的长期结果。颞叶切除术效果最佳。
