Erdemir Gozde, Pestana-Knight Elia, Honomichl Ryan, Thompson Nicolas R, Lachhwani Deepak, Kotagal Prakash, Wyllie Elaine, Gupta Ajay, Bingaman William E, Moosa Ahsan N V
Epilepsy Center, Cleveland Clinic, Cleveland, OH, 44195, United States; Division of Pediatric Neurology, University of Maryland, Baltimore, MD, United States.
Epilepsy Center, Cleveland Clinic, Cleveland, OH, 44195, United States.
Epilepsy Res. 2021 Oct;176:106731. doi: 10.1016/j.eplepsyres.2021.106731. Epub 2021 Jul 27.
Prior surgical series in children with drug-resistant epileptic spasms have reported use of intracranial EEG monitoring in up to two-third of patients. We report outcome after epilepsy surgery for drug-resistant epileptic spasms in a cohort of children without the use of intracranial EEG monitoring in any of the patients.
Medical records of all consecutive children aged 5 years or under who had epilepsy surgery for epileptic spasms at Cleveland Clinic between 2000 and 2018 were reviewed. Post-operative seizure outcome and predictors of prognosis of seizure outcome were analyzed.
Seventy children with active epileptic spasms underwent surgical resections during the study period. Mean age at seizure onset was 6.8 (+9.31) months and median age at surgery was 18.5 months. An epileptogenic lesion was identified on brain MRI in all patients; 17 (24%) had bilateral abnormalities. Etiologies included malformations of cortical development (58%), perinatal infarct/encephalomalacia (39%), and tumor (3%). None of the patients had intracranial EEG. Surgical procedures included hemispherectomy (44%), lobectomy/ lesionectomy (33%), and multilobar resections (23%). Twelve children needed repeat surgery; six (50%) became seizure free after the second surgery. At six months follow-up, 73% (51/70) were seizure-free since surgery. At a mean follow-up of 4.7 years, 60% (42/70) had Engel 1 outcome. In those with seizure recurrence, 17 (60%) reported improvement. Shorter epilepsy duration (p = 0.05) and lobar or sub-lobar epileptogenic lesions (p = 0.02) predicted favorable seizure outcome at 6 months after surgery. For long term outcome, patients with bilateral abnormalities on MRI (p = 0.001), and multilobar extent on MRI (p = 0.02) were at higher risk for recurrence.
Children with drug-resistant epileptic spasms secondary to an epileptogenic lesion detected on MRI could be selected for epilepsy surgery without undergoing intracranial EEG monitoring. A surgical selection paradigm without intracranial monitoring may allow early surgery without the risks of invasive monitoring.
既往关于耐药性癫痫性痉挛患儿的外科手术系列报道称，多达三分之二的患者使用了颅内脑电图监测。我们报告了一组未对任何患者使用颅内脑电图监测的耐药性癫痫性痉挛患儿接受癫痫手术后的结果。
回顾了2000年至2018年间在克利夫兰诊所因癫痫性痉挛接受癫痫手术的所有5岁及以下连续患儿的病历。分析术后癫痫发作结果及癫痫发作结果预后的预测因素。
在研究期间，70例有活动性癫痫性痉挛的患儿接受了手术切除。癫痫发作开始时的平均年龄为6.8（±9.31）个月，手术时的中位年龄为18.5个月。所有患者的脑部磁共振成像（MRI）均发现致痫性病变；17例（24%）有双侧异常。病因包括皮质发育畸形（58%）、围产期梗死/脑软化（39%）和肿瘤（3%）。所有患者均未进行颅内脑电图检查。手术方式包括大脑半球切除术（44%）、叶切除术/病灶切除术（33%）和多叶切除术（23%）。12例患儿需要再次手术；6例（50%）在第二次手术后无癫痫发作。在6个月的随访中，73%（51/70）自手术以来无癫痫发作。在平均4.7年的随访中，60%（42/70）达到恩格尔1级结果。在癫痫复发的患儿中，17例（60%）病情有所改善。癫痫持续时间较短（p = 0.05）以及叶或叶下致痫性病变（p = 0.02）可预测术后6个月癫痫发作结果良好。对于长期结果，MRI显示双侧异常的患者（p = 0.001）以及MRI上多叶范围的患者（p = 0.02）复发风险较高。
对于磁共振成像检测到继发于致痫性病变的耐药性癫痫性痉挛患儿，可选择不进行颅内脑电图监测而直接进行癫痫手术。无需颅内监测的手术选择模式可使患儿早日接受手术，而避免有创监测的风险。
