Downes Michelle, Greenaway Rebecca, Clark Maria, Helen Cross J, Jolleff Nicola, Harkness William, Kaliakatsos Marios, Boyd Stewart, White Steve, Neville Brian G R
UCL Institute of Child Health, London, United Kingdom.
Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom.
Epilepsia. 2015 Nov;56(11):1760-6. doi: 10.1111/epi.13132. Epub 2015 Sep 4.
To determine whether multiple subpial transection in the posterior temporal lobe has an impact on long-term outcome in children who have drug-resistant Landau-Kleffner syndrome (LKS) or other "electrical status epilepticus during sleep" (ESES)-related regression. Given the wide variability in outcomes reported in the literature, a secondary aim was to explore predictors of outcome.
The current study includes a surgery group (n = 14) comprising patients who underwent multiple subpial transection of the posterior temporal lobe and a nonsurgery comparison group (n = 21) comprising patients who underwent presurgical investigations for the procedure, but who did not undergo surgery. Outcomes were assessed utilizing clinical note review as well as direct assessment and questionnaires.
The distribution of nonclassical cases was comparable between groups. There were some differences between the surgery and nonsurgery groups at presurgical investigation including laterality of discharges, level of language impairment, and age; therefore, follow-up analyses focused on change over time and predictors of outcome. There were no statistically significant differences between the groups in language, nonverbal ability, adaptive behavior, or quality of life at follow-up. There was no difference in the proportion of patients showing improvement or deterioration in language category over time for either group. Continuing seizures and an earlier age of onset were most predictive of poorer quality of life at long-term follow-up (F2,23 = 26.2, p = <0.001, R(2) = 0.714).
Both surgery and nonsurgery groups had similar proportions of classic LKS and ESES-related regression. Because no significant differences were found in the changes observed from baseline to follow-up between the two groups, it is argued that there is insufficient evidence to suggest that multiple subpial transection provides additional benefits over and above the mixed recovery often seen in LKS and related regressive epilepsies.
确定颞叶后部多处软膜下横切术对耐药性Landau-Kleffner综合征（LKS）或其他与“睡眠期癫痫性电持续状态”（ESES）相关的退行性变儿童的长期预后是否有影响。鉴于文献报道的预后差异很大，次要目的是探索预后的预测因素。
本研究包括一个手术组（n = 14），该组患者接受了颞叶后部多处软膜下横切术；以及一个非手术对照组（n = 21），该组患者接受了该手术的术前检查，但未接受手术。通过临床记录回顾、直接评估和问卷调查来评估预后。
非典型病例在两组之间的分布具有可比性。手术组和非手术组在术前检查时有一些差异，包括放电的侧别、语言障碍程度和年龄；因此，随访分析集中在随时间的变化和预后的预测因素上。随访时，两组在语言、非语言能力、适应性行为或生活质量方面没有统计学上的显著差异。两组中随时间语言类别改善或恶化的患者比例没有差异。持续癫痫发作和发病年龄较早最能预测长期随访时较差的生活质量（F2,23 = 26.2，p = <0.001，R(2) = 0.714）。
手术组和非手术组中经典LKS和与ESES相关的退行性变的比例相似。由于两组从基线到随访观察到的变化没有显著差异，因此有人认为没有足够的证据表明多处软膜下横切术比LKS和相关退行性癫痫中常见的混合恢复有额外的益处。
