Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A; Department of Child Neurology, Hospital Sant Joan de Déu, University of Barcelona, Spain.
Epilepsia. 2015 Feb;56(2):263-72. doi: 10.1111/epi.12908. Epub 2015 Jan 20.
To quantify the life expectancy of surgically eligible children with refractory epilepsy comparing two treatment strategies: medical treatment only versus epilepsy surgery.
Decision analysis model populated with available parameters from the literature. One- and two-way sensitivity analyses and second-order Monte Carlo simulations evaluated the robustness of the results across wide variations of the input parameters. The time horizon was lifetime and the main outcome was life expectancy.
Across the range of pediatric ages, epilepsy surgery yielded a higher life expectancy. For a cohort of 10-year-old children with refractory epilepsy, the gain in life expectancy with epilepsy surgery (compared to medical treatment only) was 5.9 years for temporal epilepsy and 5.6 years for extratemporal epilepsy. One- and two-way sensitivity analyses and second-order Monte Carlo simulations demonstrated the robustness of results across a wide variation of input parameters. There was no adjustment for quality of life, but we estimated the percentage of life expectancy spent in seizure freedom. For a cohort of 10-year-old patients with refractory epilepsy: (1) in temporal lobe epilepsy, epilepsy surgery yielded 48.9% of life expectancy years in seizure freedom while medical treatment yielded 14.3%; and (2) in extratemporal epilepsy, epilepsy surgery yielded 43.0% of life expectancy years in seizure freedom while medical treatment yielded 14.3%.
Epilepsy surgery yields a substantially higher life expectancy than continued medical treatment for surgically eligible children with refractory epilepsy. This conclusion remains robust across a wide range of parameter variations.
通过比较两种治疗策略（仅药物治疗与癫痫手术），量化手术适应证儿童难治性癫痫的预期寿命。
采用决策分析模型，根据文献中的可用参数进行填充。单因素和双因素敏感性分析以及二级蒙特卡罗模拟评估了在输入参数广泛变化情况下结果的稳健性。时间范围为终生，主要结果为预期寿命。
在儿科年龄范围内，癫痫手术可获得更高的预期寿命。对于一组 10 岁患有难治性癫痫的儿童，癫痫手术（与仅药物治疗相比）可增加 5.9 年的预期寿命，颞叶癫痫为 5.9 年，颞叶外癫痫为 5.6 年。单因素和双因素敏感性分析以及二级蒙特卡罗模拟表明，在输入参数广泛变化的情况下，结果具有稳健性。未对生活质量进行调整，但我们估计了无癫痫发作状态下的预期寿命比例。对于一组 10 岁患有难治性癫痫的患者：（1）在颞叶癫痫中，癫痫手术可使 48.9%的预期寿命无癫痫发作，而药物治疗仅为 14.3%；（2）在颞叶外癫痫中，癫痫手术可使 43.0%的预期寿命无癫痫发作，而药物治疗仅为 14.3%。
对于有手术适应证的难治性癫痫儿童，癫痫手术比持续药物治疗可显著提高预期寿命。这一结论在广泛的参数变化范围内仍然稳健。
