Englot Dario J, Rolston John D, Wang Doris D, Sun Peter P, Chang Edward F, Auguste Kurtis I
Department of Neurological Surgery, University of California, San Francisco, CA 94143-0112, USA.
J Neurosurg Pediatr. 2013 Aug;12(2):134-41. doi: 10.3171/2013.5.PEDS12526. Epub 2013 Jun 14.
Temporal lobe epilepsy (TLE) is the most common form of epilepsy in adults and is responsible for 15%-20% of epilepsy cases in children. Class I evidence strongly supports the use of temporal lobectomy for intractable TLE in adults, but fewer studies have examined seizure outcomes and predictors of seizure freedom after temporal lobectomy in pediatric patients. The authors performed a systematic review and meta-analysis of studies including 10 or more pediatric patients (age ≤ 19 years) published over the last 20 years examining seizure outcomes after temporal lobectomy for TLE. Thirty-six studies met their inclusion criteria. These 36 studies included 1318 pediatric patients with a mean age (± SEM) of 10.7 ± 0.3 years. Overall, seizure freedom (Engel Class I outcome) was achieved in 1002 cases (76%); 316 patients (24%) continued to have seizures (Engel Class II-IV outcome). All patients had at least 1 year of follow-up. Statistically significant predictors of seizure freedom after surgery included lesional epilepsy etiology (odds ratio [OR] 1.08, 95% confidence interval [CI] 1.02-1.15), abnormal findings on preoperative MRI (OR 1.27, 95% CI 1.16-1.40), and lack of generalized seizures (OR 1.36, 95% CI 1.20-1.56). Among lesional epilepsy cases, there was a trend toward better outcome with gross-total lesionectomy than with subtotal resection. Approximately three-fourths of pediatric patients with TLE attain seizure freedom after temporal lobectomy. Favorable outcomes may be predicted by lesional epilepsy etiology, abnormal MRI, and lack of generalized seizures. Pediatric patients with medically refractory TLE should be referred to a comprehensive pediatric epilepsy center for surgical evaluation.
颞叶癫痫（TLE）是成人中最常见的癫痫类型，占儿童癫痫病例的15%-20%。一级证据强烈支持对成人难治性TLE采用颞叶切除术，但较少有研究探讨小儿患者颞叶切除术后的癫痫发作结局及无癫痫发作的预测因素。作者对过去20年发表的纳入10名或更多小儿患者（年龄≤19岁）的研究进行了系统评价和荟萃分析，这些研究探讨了TLE颞叶切除术后的癫痫发作结局。36项研究符合纳入标准。这36项研究包括1318例小儿患者，平均年龄（±标准误）为10.7±0.3岁。总体而言，1002例（76%）实现了无癫痫发作（恩格尔一级结局）；316例患者（24%）仍有癫痫发作（恩格尔二级至四级结局）。所有患者均至少随访1年。术后无癫痫发作的统计学显著预测因素包括病灶性癫痫病因（比值比[OR]1.08，95%置信区间[CI]1.02-1.15）、术前MRI异常表现（OR 1.27，95%CI 1.16-1.40）和无全身性癫痫发作（OR 1.36，95%CI 1.20-1.56）。在病灶性癫痫病例中，大体全病灶切除术的结局有优于次全切除术的趋势。大约四分之三的小儿TLE患者在颞叶切除术后实现了无癫痫发作。病灶性癫痫病因、MRI异常和无全身性癫痫发作可能预示着良好的结局。药物难治性TLE的小儿患者应转诊至综合小儿癫痫中心进行手术评估。
