Lamberink Herm J, Boshuisen Kim, van Rijen Peter C, Gosselaar Peter H, Braun Kees P J
Department of (Child) Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.
Epilepsia. 2015 May;56(5):717-25. doi: 10.1111/epi.12974. Epub 2015 Apr 3.
Over the past decades, the number of epilepsy surgeries in children has increased and indications for surgery have broadened. We studied the changes in patient characteristics between 1990 and 2011 in a nationwide cohort and related these to seizure outcome and postoperative medication status. Second, we tried to identify predictors for seizure outcome after pediatric epilepsy surgery.
To study changes over time, we divided this retrospective cohort of 234 children into two consecutive time periods of 11 years, and statistically compared the epochs in terms of patient characteristics, surgical variables, complications, seizure outcome, and postoperative medication status. To identify predictors of postoperative seizure freedom, we performed univariable and multivariable logistic regression analyses.
The number of surgeries per year increased from an average of 5 in the first, to 16 in the past epoch. Over time, significantly more surgeries were performed for malformations of cortical development, and more patients underwent magnetoencephalography (MEG) and invasive monitoring. Four percent of patients had a serious complication. Complete seizure freedom (Engel class IA) at 2 years after surgery was achieved in 74% of patients, which did not change significantly over time. The proportion of patients who were free from seizures and antiepileptic medication 2 years after surgery significantly increased from 13% to 32%. Factors predictive of seizure recurrence were preoperative intracranial monitoring, multilobar surgery, etiology, and longer duration of epilepsy before surgery.
Although more complex cases were operated over time and medication was withdrawn earlier after surgery, success rates at 2 years remained stable. In combination with low complication rates, this underscores the efficacy and safety of pediatric epilepsy surgery. It is important to consider epilepsy surgery early, as longer duration of epilepsy increased the risk of postoperative seizure recurrence.
在过去几十年中，儿童癫痫手术的数量有所增加，手术适应症也有所拓宽。我们研究了1990年至2011年全国范围内一组队列中患者特征的变化，并将这些变化与癫痫发作结果及术后用药情况相关联。其次，我们试图确定小儿癫痫手术后癫痫发作结果的预测因素。
为研究随时间的变化，我们将这一包含234名儿童的回顾性队列分为两个连续的11年时间段，并对两个时期的患者特征、手术变量、并发症、癫痫发作结果及术后用药情况进行统计学比较。为确定术后无癫痫发作的预测因素，我们进行了单变量和多变量逻辑回归分析。
每年的手术数量从第一个时期的平均5例增加到过去时期的16例。随着时间的推移，因皮质发育畸形进行的手术显著增多，接受脑磁图（MEG）和侵入性监测的患者也更多。4%的患者出现严重并发症。74%的患者在术后2年实现了完全无癫痫发作（恩格尔IA级），且这一比例随时间没有显著变化。术后2年无癫痫发作且停用抗癫痫药物的患者比例从13%显著增至32%。癫痫复发的预测因素包括术前颅内监测、多叶手术、病因及术前癫痫持续时间较长。
尽管随着时间的推移手术的病例更为复杂，且术后更早停用药物，但2年的成功率保持稳定。结合低并发症发生率，这凸显了小儿癫痫手术的有效性和安全性。尽早考虑癫痫手术很重要，因为癫痫持续时间越长，术后癫痫复发的风险越高。
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