Yum Mi-Sun, Ko Tae-Sung, Lee Jung Kyo, Hong Seokho, Kim Deok Soo, Kim Jeongho
Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Clin Neurol Neurosurg. 2011 Apr;113(3):213-7. doi: 10.1016/j.clineuro.2010.11.010. Epub 2010 Dec 13.
Focal epileptogenic lesions can manifest as infantile spasms, a catastrophic type of epilepsy. Although early surgery for catastrophic epilepsies has shown positive effects, little is known regarding long-term outcomes. The present study examined long-term outcomes in patients with localization-related infantile spasms treated surgically.
Data from localization-related infantile spasm cases treated surgically between 1998 and 2002 at the Asan Medical Center were retrospectively reviewed. Presurgical evaluation, surgery, postoperative seizure frequency and developmental outcome data were analyzed.
Five patients met the inclusion criteria, and had etiologies of tuberous sclerosis, fetal infection, encephalomalacia, malformation of cortical development and low-grade astrocytoma, respectively. The mean seizure onset age was 5.4 months (range, 3 days to 11 months), and the mean age at surgery was 19 months (range, 9-29 months). Two patients underwent a functional hemispherectomy, and the remaining three underwent lesionectomy or temporal lobectomy. The follow-up duration was 6-9 years. We found that following surgery, 4 of the 5 patients were seizure-free at the final follow-up. The 2 patients with low grade astrocytoma and cortical dysplasia, respectively showed relatively good developmental outcomes.
Surgery may be an excellent option for treating selected patients with infantile spasms due to unilateral or focal congenital or early-acquired cortical lesions. However, developmental outcomes appear to be strongly linked to etiology and the pre-operative developmental level.
局灶性致痫性病变可表现为婴儿痉挛症，这是一种严重的癫痫类型。尽管早期手术治疗严重癫痫已显示出积极效果，但关于长期预后的了解却很少。本研究调查了接受手术治疗的局限性相关婴儿痉挛症患者的长期预后。
回顾性分析了1998年至2002年在峨山医学中心接受手术治疗的局限性相关婴儿痉挛症病例的数据。分析了术前评估、手术、术后癫痫发作频率和发育结局数据。
5例患者符合纳入标准，病因分别为结节性硬化症、胎儿感染、脑软化、皮质发育畸形和低级别星形细胞瘤。平均癫痫发作起始年龄为5.4个月（范围3天至11个月），平均手术年龄为19个月（范围9至29个月）。2例患者接受了功能性大脑半球切除术，其余3例接受了病灶切除术或颞叶切除术。随访时间为6至9年。我们发现，术后5例患者中有4例在最后一次随访时无癫痫发作。2例分别患有低级别星形细胞瘤和皮质发育异常的患者发育结局相对较好。
对于因单侧或局灶性先天性或早期获得性皮质病变导致婴儿痉挛症的特定患者，手术可能是一种很好的治疗选择。然而，发育结局似乎与病因和术前发育水平密切相关。
