Gröppel Gudrun, Dorfer Christian, Dressler Anastasia, Mühlebner Angelika, Porsche Barbara, Hainfellner Johann A, Czech Thomas, Feucht Martha
Epilepsy Monitoring Unit, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna/General Hospital (AKH) Vienna, Vienna, Austria.
Department of Neurosurgery, Medical University of Vienna/General Hospital (AKH) Vienna, Vienna, Austria.
Dev Med Child Neurol. 2017 Jan;59(1):89-97. doi: 10.1111/dmcn.13233. Epub 2016 Aug 25.
To study the effect of hemispherotomy on electrical status epilepticus in sleep (ESES) and language development.
Children with a confirmed diagnosis of ESES prior to surgery and a minimum of 24 months of developmental follow-up data were compared with age-matched controls without ESES. Language quotients (LQs) were calculated before and after surgery.
Eleven patients (five females, six males) and 21 controls (11 females, 10 males) were included. Before surgery a significantly higher number of children in the study group (n=9) demonstrated severe developmental delay compared with children in the control group (n=13; p=0.015). In the study group ESES remitted immediately after surgery in 10 children, and a significant catch-up in LQs was observed in this group (preoperative mean 40.0 [standard deviation (SD) 22.2, interquartile range (IQR) 30.0-62.0]; postoperative mean 73.0 [SD 33.5, IQR 41.0-97.0]; p=0.037). There was no significant difference compared with controls at last follow-up after surgery (study group: five with severe impairment; control group: eight with severe impairment [p=0.971]). Overall, a favourable developmental outcome was associated with freedom from seizures (seizure-free group: median preoperative LQ 61.5, median postoperative LQ 78.0 [p=0.017]; seizure group: median preoperative LQ 35.5, median postoperative LQ 56.5 [p=0.273]) and antiepileptic drug withdrawal (off medication: median preoperative LQ 49.5, median postoperative LQ 78.0 [p=0.011]; on medication: median preoperative LQ 78.0, median postoperative LQ 83.5 [p=0.889]).
Children with ESES showed significantly lower preoperative language abilities than children without ESES. In cases with remission of ESES after surgery, marked improvement in LQs was noticed. This improvement cannot be fully explained by seizure-freedom alone as seizure-free children without preoperative ESES showed less improvement.
研究大脑半球切除术对睡眠期癫痫性电持续状态（ESES）及语言发育的影响。
将手术前确诊为ESES且有至少24个月发育随访数据的儿童与年龄匹配的无ESES的对照组进行比较。计算手术前后的语言商数（LQ）。
纳入11例患者（5例女性，6例男性）和21例对照组（11例女性，10例男性）。手术前，研究组中严重发育迟缓的儿童数量（n = 9）显著高于对照组（n = 13；p = 0.015）。研究组中10例儿童术后ESES立即缓解，且该组LQ有显著追赶（术前平均40.0[标准差（SD）22.2，四分位数间距（IQR）30.0 - 62.0]；术后平均73.0[SD 33.5，IQR 41.0 - 97.0]；p = 0.037）。术后最后一次随访时与对照组相比无显著差异（研究组：5例严重受损；对照组：8例严重受损[p = 0.971]）。总体而言，良好的发育结局与无癫痫发作相关（无癫痫发作组：术前LQ中位数61.5，术后LQ中位数78.0[p = 0.017]；癫痫发作组：术前LQ中位数35.5，术后LQ中位数56.5[p = 0.273]）以及停用抗癫痫药物相关（停药：术前LQ中位数49.5，术后LQ中位数78.0[p = 0.011]；用药：术前LQ中位数78.0，术后LQ中位数83.5[p = 0.889]）。
ESES患儿术前语言能力显著低于无ESES的儿童。术后ESES缓解的病例中，LQ有明显改善。这种改善不能仅用无癫痫发作来完全解释，因为术前无ESES的无癫痫发作儿童改善较少。
