Dupont Sophie, Tanguy Marie-Laure, Clemenceau Stephane, Adam Claude, Hazemann Paule, Baulac Michel
Unité d'Epileptologie, Clinique Neurologique Paul Castaigne, Paris, France.
Epilepsia. 2006 Dec;47(12):2115-24. doi: 10.1111/j.1528-1167.2006.00852.x.
To assess the seizure-freedom rates and self-perceived psychosocial changes associated with the long-term outcome of epilepsy surgery in patients with refractory medial temporal lobe epilepsy associated with hippocampal sclerosis.
A standard questionnaire was given to 183 patients who underwent surgery between 1988 and 2004, and 110 were completed.
The mean duration of follow-up after surgery was 7 years, with a maximum of 17 years. The probability that patients were seizure-free after surgery was dependent on the definition of the seizure freedom. For the patients who were seizure-free since surgery (Engel's class Ia), the probability was 97.6% at 1 year after surgery, 85.2% at 2 years after surgery, 59.5% at 5 years after surgery, and 42.6% at 10 years after surgery. For the patients who still experienced rare disabling seizures after surgery but were seizure-free at least 1 year before the time of assessment, the probability was of 97.6% at 1 year after surgery, 95% at 2 years after surgery, 82.8% at 5 years after surgery, and 71.1% at 10 years after surgery. The psychosocial long-term outcome, as measured by indices of driving, employment, familial and social relationships, and marital status, was similar to the psychosocial short-term outcome. It did not depend on seizure freedom or on follow-up time interval and was not influenced statistically by seizure frequency in cases of persisting seizures. Most but not all patients noticed a substantial overall improvement in their psychosocial condition; 48% drove (increased by 7%), 47% improved (14% worsened) in their employment status, and 68% improved (5% worsened) in their familial and social relationships. Overall, 91% of patients were satisfied with the surgery, and 92% did not regret their decision.
The results of this study suggest that temporal lobe surgery has real long-term benefits. Two specific conclusions emerge: (a) the long-term rates of freedom from seizure depend on how seizure freedom is defined, and (b) the psychosocial long-term outcome does not change dramatically over years and does not depend on seizure freedom.
评估与内侧颞叶癫痫伴海马硬化的难治性患者癫痫手术长期预后相关的无癫痫发作率及自我感知的心理社会变化。
向1988年至2004年间接受手术的183例患者发放标准问卷，110例完成问卷。
术后平均随访时间为7年，最长达17年。术后患者无癫痫发作的概率取决于无癫痫发作的定义。对于术后即无癫痫发作的患者（恩格尔Ia级），术后1年无癫痫发作的概率为97.6%，术后2年为85.2%，术后5年为59.5%，术后10年为42.6%。对于术后仍有罕见致残性发作但在评估前至少1年无癫痫发作的患者，术后1年无癫痫发作的概率为97.6%，术后2年为95%，术后5年为82.8%，术后10年为71.1%。通过驾驶、就业、家庭和社会关系以及婚姻状况等指标衡量的心理社会长期预后与心理社会短期预后相似。它不取决于无癫痫发作情况或随访时间间隔，在仍有发作的情况下也不受发作频率的统计学影响。大多数但并非所有患者都注意到其心理社会状况有显著的整体改善；48%的患者开车（增加了7%），47%的患者就业状况改善（14%恶化），68%的患者家庭和社会关系改善（5%恶化）。总体而言，91%的患者对手术满意，92%的患者不后悔自己的决定。
本研究结果表明颞叶手术具有切实的长期益处。得出两个具体结论：（a）长期无癫痫发作率取决于无癫痫发作的定义方式，（b）心理社会长期预后多年来不会发生显著变化，且不取决于无癫痫发作情况。
