Shioda Mutsuki, Oguni Hirokazu, Ito Yasushi, Ochiai Taku, Hori Tomokatsu, Muto Ayako, Takahashi Satornu, Miyamoto Akie, Osaka Hitoshi, Osawa Makiko
Department of Pediatrics, Tokyo Women's Medical University, Tokyo.
No To Hattatsu. 2011 Sep;43(5):373-7.
We investigated seizure, intelligence quotient (IQ), and neurological outcomes including the process of motor function recovery after functional right hemispherectomy in 3 children with Rasmussen's encephalitis (RE). Before the procedure, they were unable to walk, nor sit without support due to progressive worsening of left hemiplegia and relentless epilepsia partialis continua (EPC) of the left extremities, which were refractory to antiepileptic drug and immunological treatment. After functional right hemispherectomy, EPC completely disappeared, although complete left hemiplegia was sustained. However, they recovered up to being able to walk independently with assistance devices, and to have an ordinary life with family support within 1.5 to 5 months through rehabilitation. At the same time, the interictal EEG improved on the unaffected side of hemisphere, exhibiting a posterior alpha rhythm. Their IQ also improved, and they were able to attend school. Early functional hemispherectomy should be considered before patients with RE are left in a serious condition due to progressive worsening of hemiplegia and seizures refractory to the available treatment.
我们对3例患有拉斯穆森脑炎(RE)的儿童在进行功能性右半球切除术后的癫痫发作、智商(IQ)和神经学转归进行了研究,包括运动功能恢复过程。术前,由于左半身瘫痪进行性加重以及左上肢持续性癫痫部分性发作(EPC)难以控制,且抗癫痫药物和免疫治疗无效,他们无法行走,在无支撑的情况下也无法坐立。功能性右半球切除术后,尽管左半身瘫痪仍持续存在,但EPC完全消失。然而,通过康复治疗,他们在1.5至5个月内恢复到能够借助辅助设备独立行走,并在家人支持下过上正常生活。同时,发作间期脑电图在未受影响的半球侧有所改善,呈现出后α节律。他们的智商也有所提高,能够上学。对于RE患者,在因半身瘫痪进行性加重和现有治疗难以控制的癫痫发作而病情严重之前,应考虑早期进行功能性半球切除术。