Department of Neurology, Krishna Institute of Medical Sciences, Hyderabad, Andhra Pradesh, India.
Neurol India. 2011 Jan-Feb;59(1):30-6. doi: 10.4103/0028-3886.76854.
To assess outcome of epilepsy surgery in children with medically refractory partial epilepsy evaluated with non-invasive protocol and to determine the predictors of outcome.
Retrospective analysis of presurgical, surgical, and postsurgical data was performed in 87 children who had at least 1 year post surgery follow-up. Outcome was assessed according to Engel's outcome classification. Stepwise regression followed by logistic regression analysis was employed in data analysis.
Mean follow-up was 32 (12-58) months and 44 (50.6%) were males. The age of onset of epilepsy was below the age of 2 years in 24 (30.8%). Resective surgery was done in 78 children. The commonest surgery performed was a temporal resection (88.9%) in adolescents and an extra-temporal resection ( 60.6%) in children. The commonest pathology was hippocampal sclerosis (HS) in adolescents and developmental, tumoral lesions, and gliosis in children. At last follow-up, 50 (64.1%) were seizure free and Engel's favourable outcome was noted in 59 (75.6%). After stepwise regression analysis, variables found to be significant (P < 0.05) and predicting a favourable outcome were lesion on MRI, normal IQ, and partial seizures without secondary generalization. Bilateral spikes on interictal EEG and acute postoperative seizures were predictors of poor outcome. A regression model was developed; the sensitivity, specificity, accuracy, and area under ROC curve were 82%, 91%, 88.5%, and 0.97%, respectively.
Favourable outcome after epilepsy surgery can be obtained in children with temporal lobe epilepsy with HS and lesion-related epilepsies in developing countries with limited resources, after evaluation with a non-invasive protocol.
评估采用非侵入性方案评估的药物难治性部分性癫痫儿童的癫痫手术结果，并确定结局的预测因素。
对 87 例至少有 1 年术后随访的患儿进行术前、手术和术后数据的回顾性分析。根据恩格尔结局分类评估结局。数据分析采用逐步回归和逻辑回归分析。
平均随访时间为 32（12-58）个月，44 例（50.6%）为男性。癫痫发作的发病年龄在 2 岁以下的有 24 例（30.8%）。78 例患儿行切除术。最常见的手术是青少年的颞叶切除术（88.9%）和儿童的颞外切除术（60.6%）。最常见的病变是青少年的海马硬化（HS）和儿童的发育性、肿瘤性病变和神经胶质增生。最后一次随访时，50 例（64.1%）无癫痫发作，59 例（75.6%）恩格尔结局良好。经过逐步回归分析，发现有统计学意义（P<0.05）且预测良好结局的变量是 MRI 上的病变、正常智商和无继发性全身发作的部分性发作。发作间期脑电图上的双侧棘波和急性术后发作是不良结局的预测因素。建立了一个回归模型；其敏感性、特异性、准确性和 ROC 曲线下面积分别为 82%、91%、88.5%和 0.97%。
在资源有限的发展中国家，采用非侵入性方案评估后，颞叶癫痫伴 HS 和病变相关癫痫的儿童可获得良好的癫痫手术结果。
