López-Rivera Javier A, Smuk Victoria, Leu Costin, Nasr Gaelle, Vegh Deborah, Stefanski Arthur, Pérez-Palma Eduardo, Busch Robyn, Jehi Lara, Najm Imad, Blümcke Ingmar, Lal Dennis
Department of Molecular Medicine, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, USA.
Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, USA.
Epilepsy Behav Rep. 2022 Feb 11;18:100527. doi: 10.1016/j.ebr.2022.100527. eCollection 2022.
Epilepsy surgery is an effective treatment option for drug-resistant focal epilepsy patients with associated structural brain lesions. However, little epidemiological data are available regarding the number of patients with these lesions. We reviewed data regarding (1) the prevalence and incidence of epilepsy; (2) the proportion of epilepsy patients with focal epilepsy, drug-resistant epilepsy, and drug-resistant focal epilepsies; and (3) the number of epilepsy presurgical evaluations and surgical resections. We also assessed the relative proportion of brain lesions using post-surgical histopathological findings from 541 surgical patients from the Cleveland Clinic and 9,523 patients from a European multi-center cohort. Data were combined to generate surgical candidate incidence and prevalence estimates and the first lesion-specific estimates for hippocampal sclerosis (HS), low-grade epilepsy-associated brain tumors (LEAT), malformations of cortical development (MCD), glial scars, vascular malformations, and encephalitis. The most frequently diagnosed brain lesions were HS (incidence = 2.32 ± 0.26 in 100,000, prevalence = 19.40 ± 2.16 in 100,000) for adults and MCD (incidence = 1.15 ± 0.34 in 100,000, prevalence = 6.52 ± 1.89 in 100,000) for children. Our estimates can guide patient advocacy groups, clinicians, researchers, policymakers in education, development of health care strategy, resource allocation, and reimbursement schedules.
癫痫手术是治疗伴有脑结构性病变的耐药性局灶性癫痫患者的一种有效选择。然而，关于这些病变患者数量的流行病学数据却很少。我们回顾了以下数据：（1）癫痫的患病率和发病率；（2）局灶性癫痫、耐药性癫痫和耐药性局灶性癫痫患者在癫痫患者中所占的比例；（3）癫痫术前评估和手术切除的数量。我们还利用克利夫兰诊所541例手术患者和一个欧洲多中心队列9523例患者的术后组织病理学检查结果，评估了脑部病变的相对比例。综合各项数据，得出了手术候选者的发病率和患病率估计值，以及对海马硬化（HS）、低度癫痫相关脑肿瘤（LEAT）、皮质发育畸形（MCD）、胶质瘢痕、血管畸形和脑炎的首个病变特异性估计值。最常诊断出的脑部病变，成人是HS（发病率=每10万人中2.32±0.26，患病率=每10万人中19.40±2.16），儿童是MCD（发病率=每10万人中1.15±0.34，患病率=每10万人中6.52±1.89）。我们的估计值可为患者权益倡导组织、临床医生、研究人员以及教育、医疗保健战略制定、资源分配和报销计划等方面的政策制定者提供指导。
