Ramantani Georgia, Stathi Angeliki, Brandt Armin, Strobl Karl, Schubert-Bast Susanne, Wiegand Gert, Korinthenberg Rudolf, van Velthoven Vera, Zentner Josef, Schulze-Bonhage Andreas, Bast Thomas
Epilepsy Center, University Hospital Freiburg, Freiburg, Germany.
Epilepsy Center Kork, Kehl-Kork, Germany.
Epilepsia. 2017 Mar;58(3):412-419. doi: 10.1111/epi.13654. Epub 2017 Jan 18.
We aimed to investigate the long-term seizure outcome of children and adolescents who were undergoing epilepsy surgery in the parietooccipital cortex and determine their predictive factors.
We retrospectively analyzed the data of 50 consecutive patients aged 11.1 (mean) ± 5.1 (standard deviation) years at surgery. All patients but one had a magnetic resonance imaging (MRI)-visible lesion. Resections were parietal in 40%, occipital in 32%, and parietooccipital in 28% cases; 24% patients additionally underwent a resection of the posterior border of the temporal lobe. Etiology included focal cortical dysplasia in 44%, benign tumors (dysembryoplastic neuroepithelial tumor, ganglioglioma, angiocentric glioma, and pilocystic astrocytoma) in 32%, peri- or postnatal ischemic lesions in 16%, and tuberous sclerosis in 8% cases.
At last follow-up (mean 8 years, range 1.5-18 years), 60% patients remained seizure-free (Engel class I): 30% had discontinued and 20% had reduced antiepileptic drugs. Most seizure recurrences (71%) occurred within the first 6 months, and only three patients presented with seizures ≥2 years after surgery. Independent predictors of seizure recurrence included left-sided as well as parietal epileptogenic zones and resections. Longer epilepsy duration to surgery was identified as the only modifiable independent predictor of seizure recurrence.
Our study demonstrates that posterior cortex epilepsy surgery is highly effective in terms of lasting seizure control and antiepileptic drug cessation in selected pediatric candidates. Most importantly, our data supports the early consideration of surgical intervention in children and adolescents with refractory posterior cortex epilepsy.
我们旨在研究接受顶枕叶皮质癫痫手术的儿童和青少年的长期癫痫发作结局，并确定其预测因素。
我们回顾性分析了50例连续手术患者的数据，这些患者手术时的年龄为11.1（平均）±5.1（标准差）岁。除1例患者外，所有患者均有磁共振成像（MRI）可见病变。40%的病例切除部位在顶叶，32%在枕叶，28%在顶枕叶；24%的患者还进行了颞叶后缘切除术。病因包括44%的局灶性皮质发育不良、32%的良性肿瘤（胚胎发育不良性神经上皮肿瘤、神经节细胞胶质瘤、血管中心性胶质瘤和毛细胞型星形细胞瘤）、16%的围生期或产后缺血性病变以及8%的结节性硬化症病例。
在最后一次随访时（平均8年，范围1.5 - 18年），60%的患者无癫痫发作（Engel I级）：30%的患者停用了抗癫痫药物，20%的患者减少了抗癫痫药物用量。大多数癫痫复发（71%）发生在术后前6个月内，只有3例患者在术后2年以上出现癫痫发作。癫痫复发的独立预测因素包括左侧以及顶叶癫痫源区和切除术。手术前癫痫发作持续时间较长被确定为癫痫复发的唯一可改变的独立预测因素。
我们的研究表明，对于选定的儿科患者，后皮质癫痫手术在持久控制癫痫发作和停用抗癫痫药物方面非常有效。最重要的是，我们的数据支持对难治性后皮质癫痫的儿童和青少年尽早考虑手术干预。
