Mühlebner Angelika, Gröppel Gudrun, Dressler Anastasia, Reiter-Fink Edith, Kasprian Gregor, Prayer Daniela, Dorfer Christian, Czech Thomas, Hainfellner Johannes A, Coras Roland, Blümcke Ingmar, Feucht Martha
Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Wien, Austria.
Department of Radiology, Medical University Vienna, Währinger Gürtel 18-20, 1090 Wien, Austria.
Epilepsy Res. 2014 Nov;108(9):1652-61. doi: 10.1016/j.eplepsyres.2014.08.012. Epub 2014 Aug 30.
To determine long-term efficacy and safety of epilepsy surgery in children and adolescents with malformations of cortical development (MCD) and to identify differences in seizure outcome of the various MCD subgroups. Special focus was set on the newly introduced International League Against Epilepsy (ILAE) classification of focal cortical dysplasia (FCD).
This is a single center retrospective cross-sectional analysis of prospectively collected data.
age at surgery <18 years, pre-surgical evaluation and epilepsy surgery performed at the Vienna pediatric epilepsy center, histologically proven MCD, complete follow-up data for at least 12 months. Clinical variables evaluated: type and localization of MCD, type of surgery and a variety of clinical characteristics reported to be associated with (un-)favorable outcomes. MCD were classified following the existing classification schemes (Barkovich et al., 2012. Brain. 135, 1348-1369; Palmini et al., 2004. Neurology. 62, S2-S8) and the ILAE classification for FCD recently proposed by Blümcke in 2011. Seizure outcome was classified using the ILAE classification proposed by Wieser in 2001.
60 Patients (51.7% male) were included. Follow up was up to 14 (mean 4.4 ± 3.2) years. Mean age at surgery was 8.0 ± 6.0 (median 6.0) years; mean age at epilepsy onset was 2.9 ± 3.2 (median 2.0) years; duration of epilepsy before surgery was 4.8 ± 4.4 (median 3.0) years. 80% of the patients were seizure free at last follow-up. AEDs were successfully withdrawn in 56.7% of all patients. Extended surgery, lesion localization in the temporal lobes and absence of inter-ictal spikes in postsurgical EEG recordings were predictive of favorable seizure outcomes after surgery. However, no association was found between outcome and MCD sub-types. Epilepsy surgery is highly effective in carefully selected drug-resistant children with MCD. Surrogate markers for complete resection of the epileptogenic zone remain the only significant predictors for seizure freedom after surgery.
确定癫痫手术对患有皮质发育畸形（MCD）的儿童和青少年的长期疗效和安全性，并确定不同MCD亚组癫痫发作结果的差异。特别关注新引入的国际抗癫痫联盟（ILAE）局灶性皮质发育不良（FCD）分类。
这是一项对前瞻性收集的数据进行的单中心回顾性横断面分析。
手术年龄<18岁，在维也纳儿科癫痫中心进行术前评估和癫痫手术，组织学证实为MCD，至少有12个月的完整随访数据。评估的临床变量：MCD的类型和定位、手术类型以及据报道与（不）良结果相关的各种临床特征。根据现有分类方案（Barkovich等人，2012年。《大脑》。135，1348 - 1369；Palmini等人，2004年。《神经病学》。62，S2 - S8）以及Blümcke于2011年最近提出的FCD的ILAE分类对MCD进行分类。使用Wieser于2001年提出的ILAE分类对癫痫发作结果进行分类。
纳入60例患者（51.7%为男性）。随访长达14年（平均4.4±3.2年）。手术时的平均年龄为8.0±6.0（中位数6.0）岁；癫痫发作的平均年龄为2.9±3.2（中位数2.0）岁；手术前癫痫持续时间为4.8±4.4（中位数3.0）年。80%的患者在最后一次随访时无癫痫发作。56.7%的患者成功停用抗癫痫药物（AEDs）。扩大手术、病变位于颞叶以及术后脑电图记录中无发作间期棘波可预测手术后良好的癫痫发作结果。然而，未发现结果与MCD亚型之间存在关联。癫痫手术对精心挑选的耐药性MCD儿童非常有效。癫痫源区完全切除的替代标志物仍然是手术后无癫痫发作的唯一重要预测指标。
