Departments of Neurology, Cleveland Clinic Epilepsy Center, Cleveland Clinic, Cleveland, OH 44195, USA.
Ann Neurol. 2013 May;73(5):646-54. doi: 10.1002/ana.23862. Epub 2013 Mar 11.
To explore the prognostic implications of epilepsy duration and age at surgery for seizure outcomes after frontal lobe epilepsy (FLE) surgery.
We reviewed 158 patients who underwent FLE surgery from 1995 to 2010. The primary outcome was seizure freedom at last follow-up (Engel class IA). Analyses employed Cox proportional and multiphase hazard modeling.
The mean age at surgery was 20.4 years, and mean epilepsy duration was 12.0 years. The estimated chance of seizure freedom was 66% (95% confidence interval [CI] = 62-68) at 1 postoperative year, 52% (95% CI = 48-56) at 2 years, and 44% (95% CI = 39-49) at 5 years and beyond. Seventy-five percent of recurrences occurred within 6 postoperative months. Both younger age at surgery (<18 years) and shorter epilepsy duration (<5 years) correlated with better seizure outcomes on univariate analysis, but only epilepsy duration remained statistically significant after multivariate modeling. Independent poor prognostic indicators included left-sided resections and acute postoperative seizures (APOSs; whole model log-rank test p < 0.0001). APOSs were particularly predictive of early epilepsy recurrence, starting within 6 postoperative months (adjusted risk ratio [RR] = 4.42, p < 0.0001), whereas long epilepsy duration correlated with late recurrences (RR = 6.25, p < 0.0001). Worse outcomes were seen with longer epilepsy duration for duration cutoffs of 2, 5, and 10 years independently for adults and children, although statistical significance was only achieved in children (66% seizure free at 5 postoperative years if operated on within 5 years of epilepsy onset vs 31% if later; p = 0.01).
Early resection may improve seizure outcomes of FLE surgery, particularly in children.
探讨额叶癫痫（FLE）手术后癫痫持续时间和手术年龄对癫痫发作结果的预后意义。
我们回顾了 1995 年至 2010 年间接受 FLE 手术的 158 例患者。主要结局是最后一次随访时的无癫痫发作（Engel 分级 IA）。采用 Cox 比例和多阶段危险模型进行分析。
手术时的平均年龄为 20.4 岁，癫痫持续时间的平均为 12.0 年。术后 1 年、2 年和 5 年及以上时，无癫痫发作的估计机会分别为 66%（95%置信区间 [CI]：62-68）、52%（95% CI：48-56）和 44%（95% CI：39-49）。75%的复发发生在术后 6 个月内。单变量分析中，手术年龄较小（<18 岁）和癫痫持续时间较短（<5 年）与更好的癫痫发作结果相关，但多变量模型后只有癫痫持续时间仍具有统计学意义。独立的预后不良指标包括左侧切除和术后急性癫痫发作（APOS；全模型对数秩检验 p < 0.0001）。APOS 特别预测术后 6 个月内的早期癫痫复发（校正风险比 [RR] = 4.42，p < 0.0001），而癫痫持续时间较长则与晚期复发相关（RR = 6.25，p < 0.0001）。对于成人和儿童，无论癫痫持续时间的截断值为 2、5 还是 10 年，较长的癫痫持续时间都预示着更差的结果，但只有在儿童中具有统计学意义（癫痫发作后 5 年内手术的患者无癫痫发作率为 66%，而晚于 5 年的患者为 31%；p = 0.01）。
早期切除可能改善 FLE 手术的癫痫发作结果，特别是在儿童中。
