婴儿期癫痫手术：术后无发作和认知发育的预测因素。

Epilepsy Surgery in the First 3 Years of Life: Predictors of Seizure Freedom and Cognitive Development.

机构信息

Department of Neuropediatrics, University Medical Centre Schleswig-Holstein, Kiel, Germany.

Department of Medical Psychology and Medical Sociology, University Medical Centre Schleswig-Holstein, Kiel, Germany.

出版信息

Neurosurgery. 2019 Jun 1;84(6):E368-E377. doi: 10.1093/neuros/nyy376.

DOI:10.1093/neuros/nyy376

PMID:30137548

Abstract

BACKGROUND

Although the majority of children undergoing epilepsy surgery are younger than 3 yr at epilepsy manifestation, only few actually receive surgical treatment in early childhood. Past studies have, however, suggested that earlier intervention may correlate with superior developmental outcomes.

OBJECTIVE

To identify predictors for long-term seizure freedom and cognitive development following epilepsy surgery in the first 3 yr of life and determine the appropriate timing for surgical treatment in this age group.

METHODS

We retrospectively analyzed the data of 48 consecutive children aged 1.1 ± 0.7 yr at surgery.

RESULTS

Final surgeries comprised 52% hemispherotomies, 13% multilobar, and 35% intralobar resections. Etiology included cortical malformations in 71%, peri- or postnatal ischemic lesions in 13%, and benign tumor or tuberous sclerosis in 8% each. At last follow-up (median 4.3, range 1-14.3 yr), 60% of children remained seizure-free: 38% had discontinued antiepileptic drugs. Intralobar lesionectomy resulted more often in seizure control than multilobar or hemispheric surgery. Postsurgical seizure freedom was determined by the completeness of resection. Early postsurgical seizures were key markers of seizure recurrence. Presurgical adaptive and cognitive developmental status was impaired in 89% children. Longer epilepsy duration and larger lesion extent were detrimental to presurgical development, which, in turn, determined the postsurgical developmental outcome.

CONCLUSION

Our study demonstrates that epilepsy surgery in very young children is safe as well as efficient regarding long-term seizure freedom and antiepileptic drug cessation in selected candidates. Longer epilepsy duration is the only modifiable predictor of impaired adaptive and cognitive development, thus supporting early surgical intervention.

摘要

背景

尽管大多数在癫痫发作时年龄小于 3 岁的儿童需要接受癫痫手术，但实际上只有少数儿童在幼儿期接受手术治疗。然而，过去的研究表明，早期干预可能与更好的发育结果相关。

目的

确定在生命的头 3 年内进行癫痫手术后长期无癫痫发作和认知发展的预测因素，并确定该年龄段手术治疗的适当时机。

方法

我们回顾性分析了 48 例年龄在手术时为 1.1±0.7 岁的连续儿童的数据。

结果

最终手术包括 52%的半球切除术、13%的多叶切除术和 35%的叶内切除术。病因包括皮质畸形 71%、围产期或产后缺血性病变 13%、良性肿瘤或结节性硬化症各 8%。在最后一次随访（中位数 4.3 岁，范围 1-14.3 岁）时，60%的儿童无癫痫发作：38%已停止使用抗癫痫药物。叶内病变切除术比多叶切除术或半球切除术更常控制癫痫发作。术后无癫痫发作取决于切除的完整性。术后早期癫痫发作是癫痫复发的关键标志物。89%的儿童术前适应性和认知发育状况受损。癫痫持续时间较长和病变范围较大对术前发育不利，而术前发育又决定了术后发育结果。