Division of Pediatric Neurology, Pediatrics Department, Peking University First Hospital, Beijing, China; Department of Pediatric Epilepsy Center, Peking University First Hospital, Beijing, China.
Department of Pediatric Epilepsy Center, Peking University First Hospital, Beijing, China.
Seizure. 2018 May;58:101-109. doi: 10.1016/j.seizure.2018.03.024. Epub 2018 Mar 29.
Generalized seizures were often thought to be contraindications for hemispherectomy. However, few studies had investigated this issue comprehensively, as well as the predictors for generalized seizures in hemispheric lesion. We studied the predictors of generalized seizures and their potential link to seizure outcomes in a cohort of children who underwent hemispherectomy.
A cohort of 76 children with hemispherectomy were reviewed and dichotomized into two groups with and without generalized seizures confirmed by vEEG presurgically. All preoperative evaluation data correlated to generalized seizures and postoperative prognosis were collected and analysed.
Of 76 patients, 11 (14.5%) cases were documented with various generalized seizures, including atypical absence (54.5%, 6/11), myoclonic (45.5%, 5/11), atonic (36.4%, 4/11), myoclonic-atonic (18.2%, 2/11), myoclonic-absence (9.1%, 1/11) and spasms (9.1%). Electrical status epilepticus during sleep (ESES) was recorded in 3 patients (27.3%, 3/11). At last follow-up, 72.7% (8/11) patients remained seizure-free. ESES was a predictor of generalized seizures (χ = 4.69, P = 0.043). No correlation was found between generalized seizures and unfavourable postoperative seizure outcome (P = 0.153). For different seizure types, focal to bilateral tonic-clonic seizures (P = 0.020) and myoclonic-atonic seizures (P = 0.002) might correlate with unfavourable outcomes.
Generalized seizures were not an absolute contraindication for hemispherectomy. Those patients with ESES might experience generalized seizures presurgically. Focal to bilateral tonic-clonic seizures and myoclonic-atonic seizures pre-surgery may indicate unfavourable post-operative seizure outcomes.
全身性发作通常被认为是大脑半球切除术的禁忌证。然而，很少有研究全面探讨这个问题，也没有研究半球病变患者全身性发作的预测因素。我们研究了接受大脑半球切除术的患儿中全身性发作的预测因素及其与术后发作结局的潜在联系。
对 76 例接受大脑半球切除术的患儿进行回顾性研究，并根据术前视频脑电图（vEEG）检查是否确诊为全身性发作将其分为有或无全身性发作两组。收集并分析所有术前评估数据与全身性发作的相关性以及术后预后。
76 例患儿中，11 例（14.5%）患儿存在各种全身性发作，包括非典型失神（54.5%，6/11）、肌阵挛（45.5%，5/11）、失张力（36.4%，4/11）、肌阵挛-失张力（18.2%，2/11）、肌阵挛-失神（9.1%，1/11）和痉挛（9.1%）。3 例（27.3%，3/11）患儿记录到睡眠期电持续状态（ESES）。末次随访时，72.7%（8/11）患儿无发作。ESES 是全身性发作的预测因素（χ²=4.69，P=0.043）。但全身性发作与术后不良发作结局无相关性（P=0.153）。对于不同的发作类型，局灶性发作发展为双侧强直-阵挛发作（P=0.020）和肌阵挛-失张力发作（P=0.002）可能与不良结局相关。
全身性发作不是大脑半球切除术的绝对禁忌证。术前存在 ESES 的患者可能会发生全身性发作。术前局灶性发作发展为双侧强直-阵挛发作和肌阵挛-失张力发作可能预示着术后不良的发作结局。
