Jin Bo, Wang Jing, Zhou Jian, Wang Shuang, Guan Yuguang, Chen Shuhua
Department of Neurology, Epilepsy Center, Beijing Key Laboratory in Epilepsy, Sanbo Brain Hospital, Capital Medical University, Beijing, 100093, China.
Department of Neurology, Epilepsy Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
J Neurol. 2016 Dec;263(12):2403-2410. doi: 10.1007/s00415-016-8274-1. Epub 2016 Sep 8.
This study aimed to determine the long-term surgical outcome of pharmacoresistant epilepsy caused by focal cortical dysplasia (FCD) and to identify the important predictors of the favorable surgical outcome. The study retrospectively analyzed the data of pharmacoresistant epilepsy patients with histologically proven FCD in our epilepsy center from May 2010 to December 2014. It included 120 patients with a mean follow-up of 34.6 months. Survival analysis and multivariate regression with Cox proportional hazards model were used to evaluate the rate, stability, and predictors of seizure freedom. The estimated chance of seizure freedom was 73.0 % [95 % confidence intervals (CI), 65.2-80.8 %] at 1 year after surgery, 70.0 % (95 % CI, 62.2-77.8 %) at 2 years, and 65 % (95 % CI, 53.2-76.7 %) at 5 years and beyond. Most seizure recurrences (85.7 %) happened within 12 months after surgery. The incomplete resection of FCD, presence of interictal epileptiform discharges (IEDs) on 3-6 months postoperative electroencephalography (EEG), and presence of habitual acute postoperative seizure (APOS) were independent predictors of seizure recurrence. However, other factors, such as the FCD type and sleep-related epilepsy, did not significantly influence the surgical outcome. Before becoming pharmacoresistant epilepsy, 30 (25 %) patients responded to antiepileptic drugs with a seizure-free duration of more than 1 year. The surgical outcome is favorable in patients with FCD, which is comparable to that reported in developed countries. The incomplete resection of FCD, presence of IEDs on 3-6 months postoperative EEG, and presence of habitual APOS are powerful predictive factors for seizure recurrence after surgery.
本研究旨在确定由局灶性皮质发育不良（FCD）引起的药物难治性癫痫的长期手术效果，并找出手术良好效果的重要预测因素。该研究回顾性分析了2010年5月至2014年12月在我们癫痫中心经组织学证实为FCD的药物难治性癫痫患者的数据。研究纳入了120例患者，平均随访时间为34.6个月。采用生存分析和Cox比例风险模型进行多变量回归，以评估无癫痫发作的发生率、稳定性和预测因素。术后1年无癫痫发作的估计概率为73.0%[95%置信区间（CI），65.2 - 80.8%]，2年时为70.0%（95%CI，62.2 - 77.8%），5年及以后为65%（95%CI，53.2 - 76.7%）。大多数癫痫复发（85.7%）发生在术后12个月内。FCD切除不完全、术后3 - 6个月脑电图（EEG）出现发作间期癫痫样放电（IEDs）以及存在习惯性术后急性癫痫发作（APOS）是癫痫复发的独立预测因素。然而，其他因素，如FCD类型和睡眠相关性癫痫，对手术效果没有显著影响。在成为药物难治性癫痫之前，30例（25%）患者对抗癫痫药物有反应，癫痫发作缓解期超过1年。FCD患者的手术效果良好，与发达国家报道的结果相当。FCD切除不完全、术后3 - 6个月EEG出现IEDs以及存在习惯性APOS是术后癫痫复发的有力预测因素。
