Morales Chacón Lilia Maria, Garcia Maeso Ivan, Baez Martin Margarita M, Bender Del Busto Juan E, García Navarro María Eugenia, Quintanal Cordero Nelson, Estupiñan Díaz Bárbara, Lorigados Pedre Lourdes, Valdés Yerena Ricardo, Gonzalez Judith, Garbey Fernandez Randy, Sánchez Coroneux Abel
Epilepsy Surgery Program International Center for Neurological Restoration, 25th Ave, No 15805, Havana, Cuba.
Behav Sci (Basel). 2018 Feb 1;8(2):19. doi: 10.3390/bs8020019.
The purpose of this paper is to present a long- term electroclinical and employment follow up in temporal lobe epilepsy (TLE) patients in a comprehensive epilepsy surgery program. Forty adult patients with pharmacoresistant TLE underwent detailed presurgical evaluation. Electroencephalogram (EEG) and clinical follow up assessment for each patient were carried out. The occurrence of interictal epileptiform activity (IEA) and absolute spike frequency (ASF) were tabulated before and after 1, 6, 12, 24 and 72 months surgical treatment. Employment status pre- to post-surgery at the last evaluated period was also examined. Engel scores follow-up was described as follows: at 12 months 70% (28) class I, 10% (4) class II and 19% (8) class III-IV; at 24 months after surgery 55.2% (21) of the patients were class I, 28.9% (11) class II and 15.1% (6) class III-IV. After one- year follow up 23 (57.7%) patients were seizure and aura-free (Engel class IA). These figures changed to 47.3%, and 48.6% respectively two and five years following surgery whereas 50% maintained this condition in the last follow up period. A decline in the ASF was observed from the first year until the sixth year after surgery in relation to the preoperative EEG. The ASF one year after surgery allowed to distinguish "satisfactory" from "unsatisfactory" seizure relief outcome at the last follow up. An adequate social functioning in terms of education and employment in more than 50% of the patients was also found. Results revealed the feasibility of conducting a successful epilepsy surgery program with favorable long term electroclinical and psychosocial functioning outcomes in a developing country as well.
本文的目的是在一个综合性癫痫手术项目中，对颞叶癫痫（TLE）患者进行长期的电临床和就业随访。40例药物难治性TLE成年患者接受了详细的术前评估。对每位患者进行了脑电图（EEG）和临床随访评估。在手术治疗1、6、12、24和72个月前后，将发作间期癫痫样放电（IEA）的发生情况和绝对棘波频率（ASF）制成表格。还检查了最后评估期手术前后的就业状况。Engel评分随访情况如下：术后12个月时，70%（28例）为I级，10%（4例）为II级，19%（8例）为III-IV级；术后24个月时，55.2%（21例）患者为I级，28.9%（11例）为II级，15.1%（6例）为III-IV级。随访一年后，23例（57.7%）患者无癫痫发作和先兆（Engel IA级）。术后两年和五年时，这些数字分别变为47.3%和48.6%，而在最后一次随访期，50%的患者维持了这种状况。与术前脑电图相比，术后第一年至第六年观察到ASF下降。术后一年的ASF有助于在最后一次随访时区分癫痫发作缓解结果“满意”与“不满意”。还发现超过50%的患者在教育和就业方面具有足够的社会功能。结果表明，在一个发展中国家开展一个成功的癫痫手术项目并取得良好的长期电临床和心理社会功能结果是可行的。
