Moura Lidia M V R, Eskandar Emad N, Hassan Mursal, Salinas Joel, Cole Andrew J, Hoch Daniel B, Cash Sydney S, Hsu John
Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, United States.
Department of Neurosurgery, Massachusetts General Hospital, Boston, MA 02114, United States.
Epilepsy Res. 2016 Nov;127:358-365. doi: 10.1016/j.eplepsyres.2016.09.021. Epub 2016 Sep 30.
To compare postoperative seizure-free survival between older and younger adults.
A retrospective cohort of 107 temporal lobe epilepsy patients with a diagnosis of mesial temporal sclerosis (MTS) received anterior temporal lobectomy (ATL) between 1993 and 2014. We divided the lower three quartiles (younger) and top quartile (older, all 47+ years) of patients, then reviewed patient registry and electronic medical records to determine time to first self-reported seizure after ATL, the primary outcome (mean=3.5years of follow-up, SD=3.6). We also assessed Engel classifications, intraoperative and postoperative treatment complications, and social disability. We used Cox proportional hazard models to assess the association between individual traits and time of seizure recurrence.
During follow-up, 35/107 (32.7%) patients had post-operative seizure(s). After adjustment for potential confounders there were no significant differences in the probability of post-operative seizures between the older and younger groups, though we had limited precision (hazard ratio of 0.67 [0.28-1.59]), (p=0.36). There were more treatment complications and disability in older patients (18% vs. 1.3% for any complications, 84.62% vs. 58.23% for driving disability, and 84.6% vs. 60.7% for work disability, p<0.05).
Older patients appear to have more complications after ATL, compared with younger patients. Age, however, does not appear to have a large independent association with seizure recurrence.
比较老年人和年轻人术后无癫痫发作的生存率。
对1993年至2014年间接受前颞叶切除术（ATL）的107例诊断为内侧颞叶硬化（MTS）的颞叶癫痫患者进行回顾性队列研究。我们将患者分为下三个四分位数（较年轻组）和上四分位数（较年长组，均为47岁及以上），然后查阅患者登记资料和电子病历，以确定ATL术后首次自我报告癫痫发作的时间，这是主要结局指标（平均随访3.5年，标准差3.6）。我们还评估了恩格尔分类、术中及术后治疗并发症以及社会残疾情况。我们使用Cox比例风险模型评估个体特征与癫痫复发时间之间的关联。
随访期间，107例患者中有35例（32.7%）出现术后癫痫发作。在对潜在混杂因素进行调整后，较年长组和较年轻组术后癫痫发作的概率没有显著差异，尽管我们的精度有限（风险比为0.67[0.28 - 1.59]），（p = 0.36）。年长患者有更多的治疗并发症和残疾情况（任何并发症的发生率分别为18%和1.3%，驾驶残疾的发生率分别为84.62%和58.23%，工作残疾的发生率分别为84.6%和60.7%，p < 0.05）。
与年轻患者相比，老年患者在ATL术后似乎有更多并发症。然而，年龄似乎与癫痫复发没有很大的独立关联。
