Department of Paediatric Psychology, Sector of Neuropsychology, Rudolf Magnus Institute of Neuroscience, Utrecht, The Netherlands.
Epileptic Disord. 2011 Mar;13(1):47-55. doi: 10.1684/epd.2011.0403.
To detect change in mental development or intelligence over two years following hemispherectomy in children with pharmacologically intractable epilepsy. Seventeen infants and preschoolers (median age at epilepsy onset of 0.0 years and at hemispherectomy 1.5 years; epilepsy duration of 0.2-2.6 years) and 12 older children (median age at onset of 1.0 year and at hemispherectomy 8.3 years; epilepsy duration of 1.1-11.7 years) with pharmacologically intractable seizures due to developmental, acquired or progressive pathology. Prospective study with consecutive inclusion of children, fixed assessment intervals (shortly before and 6, 12 and 24 months after hemispherectomy) and assessment using developmental scales and intelligence scales. Dependent variables included mental developmental index (MDI), mental age (MA) and mental developmental delay (MDD) in younger children and intelligence quotient (IQ) in older children. Mental development had arrested or deteriorated prior to hemispherectomy in 14 children (82%) assessed with developmental scales. In 14 children, it was not possible to more precisely determine MDI than "below the lowest MDI that the test manual provided" either before or after hemispherectomy. MA, however, increased in 16 children. Overall, IQ changed negligibly over two years after hemispherectomy, although an individual approach revealed variability. Children with Rasmussen encephalitis did not recover from the significant presurgical deterioration of intelligence. Removal of the affected hemisphere enables epileptic children, even those with severe mental delay, to further develop mentally.
检测药物难治性癫痫儿童行半球切除术两年后精神发育或智力变化。17 名婴儿和学龄前儿童（癫痫发病中位年龄为 0.0 岁，行半球切除术中位年龄为 1.5 岁；癫痫病程为 0.2-2.6 年）和 12 名年长儿童（癫痫发病中位年龄为 1.0 岁，行半球切除术中位年龄为 8.3 岁；癫痫病程为 1.1-11.7 年）接受药物难治性癫痫治疗，病因是发育性、获得性或进行性疾病。前瞻性研究，连续纳入患儿，固定评估间隔（半球切除术前后短时间内、6、12 和 24 个月），使用发育量表和智力量表进行评估。因变量包括精神发育指数（MDI）、心理年龄（MA）和心理发育迟缓（MDD）（年龄较小的儿童）以及智商（IQ）（年龄较大的儿童）。14 名接受发育量表评估的患儿中，有 14 名（82%）术前精神发育已停止或恶化。14 名患儿在半球切除术前后，MDI 均无法精确判断，只能判断为“低于测试手册提供的最低 MDI”。然而，16 名患儿的 MA 增加。总体而言，半球切除术两年后智商变化可忽略不计，但个别患儿的智商有显著差异。Rasmussen 脑炎患儿的智力无法从术前显著恶化中恢复。切除病变半球可使癫痫患儿，即使是那些有严重精神发育迟缓的患儿，也能进一步精神发育。
