Choi Sun Ah, Kim Soo Yeon, Kim Woo Joong, Shim Young Kyu, Kim Hunmin, Hwang Hee, Choi Ji Eun, Lim Byung Chan, Chae Jong Hee, Chong Sangjoon, Lee Ji Yeoun, Phi Ji Hoon, Kim Seung Ki, Wang Kyu Chang, Kim Ki Joong
Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea.
Department of Pediatrics, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea.
J Clin Neurol. 2019 Jan;15(1):84-89. doi: 10.3988/jcn.2019.15.1.84.
This study investigated the seizure recurrence rate and potential predictors of seizure recurrence following antiepileptic drug (AED) withdrawal after resective epilepsy surgery in children with focal cortical dysplasia (FCD).
We retrospectively analyzed the records of 70 children and adolescents with FCD types I, II, and IIIa who underwent resective epilepsy surgery between 2004 and 2015 and were followed for at least 2 years after surgery.
We attempted AED withdrawal in 40 patients. The median time of starting the AED reduction was 10.8 months after surgery. Of these 40 patients, 14 patients (35%) experienced seizure recurrence during AED reduction or after AED withdrawal. Half of the 14 patients who experienced recurrence regained seizure freedom after AED reintroduction and optimization. Compared with their preoperative status, the AED dose or number was decreased in 57.1% of patients, and remained unchanged in 14.3% after surgery. A multivariate analysis found that incomplete resection (=0.004) and epileptic discharges on the postoperative EEG (=0.025) were important predictors of seizure recurrence after AED withdrawal. Over the mean follow-up duration of 4.5 years after surgery, 34 patients (48.6% of the entire cohort) were seizure-free with and without AEDs.
Children with incomplete resection and epileptic discharges on postoperative EEG are at a high risk of seizure recurrence after drug withdrawal. Complete resection of FCD may lead to a favorable surgical outcome and successful AED withdrawal after surgery.
本研究调查了局灶性皮质发育不良（FCD）患儿在切除性癫痫手术后停用抗癫痫药物（AED）后的癫痫复发率及癫痫复发的潜在预测因素。
我们回顾性分析了2004年至2015年间接受切除性癫痫手术且术后至少随访2年的70例I型、II型和IIIa型FCD儿童及青少年的病历。
我们尝试对40例患者停用AED。开始减少AED剂量的中位时间为术后10.8个月。在这40例患者中，14例（35%）在减少AED剂量期间或停用AED后出现癫痫复发。14例复发患者中有一半在重新引入并优化AED后再次实现无癫痫发作。与术前状态相比，57.1%的患者术后AED剂量或数量减少，14.3%保持不变。多变量分析发现，切除不完全（=0.004）和术后脑电图出现癫痫放电（=0.025）是停用AED后癫痫复发的重要预测因素。术后平均随访4.5年期间，34例患者（占整个队列的48.6%）无论是否使用AED均无癫痫发作。
切除不完全且术后脑电图有癫痫放电的儿童在停药后癫痫复发风险较高。FCD的完全切除可能带来良好的手术效果，并在术后成功停用AED。
