Ji Taoyun, Liu Ming, Wang Shuang, Liu Qingzhu, Wu Ye, Zhang Yuehua, Bao Xinhua, Wang Wen, Wang Ruofan, Yu Guojing, Liu Xiaoyan, Cai Lixin, Jiang Yuwu
Department of Pediatrics, Peking University First Hospital, Beijing, China.
Department of Pediatric Epilepsy Center, Peking University First Hospital, Beijing, China.
Front Neurol. 2019 Aug 14;10:880. doi: 10.3389/fneur.2019.00880. eCollection 2019.
To explore the post-hemispherotomy seizure outcome and its prognostic predictors in children with refractory epilepsy. We reviewed 83 consecutive child patients with refractory epilepsy who underwent a hemispherectomy from June 2014 to January 2017 at our Pediatric Epilepsy Center. Demographic, clinical, EEG, neuroimaging, and surgical data were collected. Seizure outcome data were collected via outpatient clinics as well as telephone visits and were graded according to Engel criteria. Logistic regression model and Cox proportional hazard regression model were, respectively, applied to explore the related factors predicting the seizure outcomes of children after a hemispherotomy. Of the 83 patients, 55 (63.2%) were male. The mean seizure onset age was 1.9 years (0-8.7 years), and the mean surgery age was 5 years (0.8-14 years). At a mean follow-up of 3 years, 69 children (83.1%) were seizure free, and 14 (16.9%) exhibited seizure recurrence. In a univariate analysis, whether or not considering follow-up time, a non-lateralized interictal EEG pattern, bilateral PET abnormalities and acute postoperative seizures (APOS) could all predict poor seizure outcomes post-hemispherotomy. Bilateral PET abnormalities were independently correlated with unfavorable seizure outcomes in the multivariate Logistic regression analysis (Odds ratio() = 13.05, 95% = 1.52-112.29 = 0.019) and in the multivariate Cox proportional hazard analysis( = 13.99, 95% = 2.75-71.17, = 0.001). Child epileptic patients with bilateral PET abnormalities may have poor seizure outcomes after a hemispherotomy procedure. This study will facilitate better candidate selection for hemispherotomies and early identification of unfavorable seizure outcomes.
探讨难治性癫痫患儿半球切除术后的癫痫发作结局及其预后预测因素。我们回顾了2014年6月至2017年1月在我们儿科癫痫中心连续接受半球切除术的83例难治性癫痫患儿。收集了人口统计学、临床、脑电图、神经影像学和手术数据。通过门诊以及电话随访收集癫痫发作结局数据，并根据恩格尔标准进行分级。分别应用逻辑回归模型和Cox比例风险回归模型来探讨预测半球切除术后儿童癫痫发作结局的相关因素。83例患者中，55例（63.2%）为男性。癫痫发作的平均起始年龄为1.9岁（0 - 8.7岁），平均手术年龄为5岁（0.8 - 14岁）。平均随访3年时，69例儿童（83.1%）无癫痫发作，14例（16.9%）出现癫痫复发。在单因素分析中，无论是否考虑随访时间，非定位性发作间期脑电图模式、双侧PET异常和急性术后癫痫发作（APOS）均能预测半球切除术后不良的癫痫发作结局。在多变量逻辑回归分析中，双侧PET异常与不良癫痫发作结局独立相关（比值比（OR） = 13.05，95%可信区间（CI） = 1.52 - 112.29，P = 0.019），在多变量Cox比例风险分析中也是如此（HR = 13.99，95%CI = 2.75 - 71.17，P = 0.001）。双侧PET异常的儿童癫痫患者在半球切除术后可能有不良的癫痫发作结局。本研究将有助于更好地选择半球切除术的候选者，并早期识别不良的癫痫发作结局。
