Hosoyama Hiroshi, Matsuda Kazumi, Mihara Tadahiro, Usui Naotaka, Baba Koichi, Inoue Yushi, Tottori Takayasu, Otsubo Toshiaki, Kashida Yumi, Iida Koji, Hirano Hirofumi, Hanaya Ryosuke, Arita Kazunori
National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka.
Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima.
J Neurosurg Pediatr. 2017 May;19(5):606-615. doi: 10.3171/2016.12.PEDS16197. Epub 2017 Mar 3.
OBJECTIVE The aim of this study was to investigate the treatment outcomes and social engagement of patients who had undergone pediatric epilepsy surgery more than 10 years earlier. METHODS Between 1983 and 2005, 110 patients younger than 16 years underwent epilepsy surgery at the National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders. The authors sent a questionnaire to 103 patients who had undergone follow-up for more than 10 years after surgery; 85 patients (82.5%) responded. The survey contained 4 categories: seizure outcome, use of antiepileptic drugs, social participation, and general satisfaction with the surgical treatment (resection of the epileptic focus, including 4 hemispherectomies). The mean patient age at the time of surgery was 9.8 ± 4.2 (SD) years, and the mean duration of postoperative follow-up was 15.4 ± 5.0 years. Of the 85 patients, 79 (92.9%) presented with a lesional pathology, such as medial temporal sclerosis, developmental/neoplastic lesions, focal cortical dysplasia, and gliosis in a single lobe. RESULTS For 65 of the 85 responders (76.5%), the outcome was recorded as Engel Class I (including 15 [93.8%] of 16 patients with medial temporal sclerosis, 20 [80.0%] of 25 with developmental/neoplastic lesions, and 27 [73.0%] of 37 with focal cortical dysplasia). Of these, 29 (44.6%) were not taking antiepileptic drugs at the time of our survey, 29 (44.6%) held full-time jobs, and 33 of 59 patients (55.9%) eligible to drive had a driver's license. Among 73 patients who reported their degree of satisfaction, 58 (79.5%) were very satisfied with the treatment outcome. CONCLUSIONS The seizure outcome in patients who underwent resective surgery in childhood and underwent followup for more than 10 years was good. Of 85 respondents, 65 (76.5%) were classified in Engel Class I. The degree of social engagement was relatively high, and the satisfaction level with the treatment outcome was also high. From the perspective of seizure control and social adaptation, resective surgery yielded longitudinal benefits in children with intractable epilepsy, especially those with a lesional pathology in a single lobe.
目的 本研究旨在调查10多年前接受小儿癫痫手术患者的治疗效果及社会参与情况。方法 1983年至2005年间，110名16岁以下患者在静冈癫痫与神经疾病研究所国家癫痫中心接受了癫痫手术。作者向103名术后接受了10年以上随访的患者发送了问卷；85名患者（82.5%）进行了回复。该调查包含4个类别：癫痫发作结果、抗癫痫药物使用情况、社会参与度以及对手术治疗（癫痫病灶切除，包括4例大脑半球切除术）的总体满意度。手术时患者的平均年龄为9.8±4.2（标准差）岁，术后平均随访时间为15.4±5.0年。85名患者中，79名（92.9%）存在病变性病理，如内侧颞叶硬化、发育性/肿瘤性病变、局灶性皮质发育不良以及单叶胶质增生。结果 85名回复者中有65名（76.5%）的结果被记录为恩格尔I级（包括16例内侧颞叶硬化患者中的15例[93.8%]、25例发育性/肿瘤性病变患者中的20例[80.0%]以及37例局灶性皮质发育不良患者中的27例[73.0%]）。其中，29名（44.6%）在我们调查时未服用抗癫痫药物，29名（44.6%）有全职工作，59名符合驾驶条件的患者中有33名（55.9%）拥有驾照。在73名报告其满意度的患者中，58名（79.5%）对治疗结果非常满意。结论 童年期接受切除性手术并接受了10年以上随访的患者癫痫发作结果良好。85名受访者中，65名（76.5%）被归类为恩格尔I级。社会参与度较高，对治疗结果的满意度也较高。从癫痫控制和社会适应的角度来看，切除性手术对难治性癫痫儿童，尤其是单叶有病变性病理的儿童产生了长期益处。
