Developmental Cognitive Neuroscience Unit, Institute of Child Health, University College London, London WC1N 1EH, UK.
Neurology. 2011 Apr 12;76(15):1330-7. doi: 10.1212/WNL.0b013e31821527f0.
Temporal lobe resection is an established treatment for medication-resistant temporal lobe epilepsy, which in recent years has increasingly been performed in children. However, little is known about the long-term outcome in these children. The aim of this study was to characterize intellectual and psychosocial functioning of children after temporal lobe resection as they progress into late adolescence and adulthood.
We report the long-term follow-up of 42 children who underwent temporal lobe surgery after an average postoperative period of 9 years. Longitudinal change in IQ was documented, psychosocial outcome including quality of life was assessed, and preoperative and postoperative T1-weighted MRI brain scans were evaluated quantitatively. A well-matched nonsurgical comparison group of 11 children with similar clinical characteristics was also assessed.
At follow-up, 86% of the surgical group were seizure-free, and 57% were no longer taking antiepileptic medication. A significant increase in IQ was found in the surgical group after an extended follow-up period of >5 years. This IQ change was not found in the nonsurgical comparison group. IQ increases were associated with cessation of antiepileptic medication and changes in MRI-derived gray matter volume. The surgical group also reported better psychosocial outcome including quality of life, which was more strongly associated with seizure freedom rather than surgery per se.
Surgery for temporal lobe epilepsy performed in childhood results in excellent long-term seizure control and favorable cognitive outcome along with positive effects on brain development.
This study provides Class III evidence that temporal lobectomy in children with temporal lobe epilepsy is associated with improved long-term intellectual outcomes compared with those undergoing standard medical treatment.
颞叶切除术是一种已被证实的治疗药物难治性颞叶癫痫的方法，近年来在儿童中越来越多地采用。然而，对于这些儿童的长期结果知之甚少。本研究的目的是描述颞叶切除术后儿童在进入青少年晚期和成年期后的智力和社会心理功能。
我们报告了 42 名儿童在平均术后 9 年后接受颞叶手术的长期随访结果。记录了智商的纵向变化，评估了包括生活质量在内的社会心理结果，并对术前和术后的 T1 加权 MRI 脑扫描进行了定量评估。还评估了具有相似临床特征的 11 名非手术对照组儿童的结果。
在随访时，手术组 86%的患者无癫痫发作，57%的患者不再服用抗癫痫药物。在延长的随访期（>5 年）后，手术组的智商显著增加。在非手术对照组中没有发现这种智商变化。智商的增加与停止抗癫痫药物和 MRI 衍生的灰质体积变化有关。手术组还报告了更好的社会心理结果，包括生活质量，这与癫痫发作的控制率而不是手术本身更为密切相关。
儿童时期进行的颞叶癫痫手术可获得良好的长期癫痫控制效果和认知结果，并对大脑发育产生积极影响。
本研究提供了 III 级证据，表明与接受标准药物治疗相比，儿童颞叶癫痫患者行颞叶切除术与改善长期智力结果相关。
