Department of Neurosurgery, Epilepsy Center, Sanbo Brain Hospital, Capital Medical University, Beijing, China.
Beijing Key Laboratory of Epilepsy, Sanbo Brain Hospital, Capital Medical University, Beijing, China.
Epilepsia Open. 2022 Dec;7(4):697-709. doi: 10.1002/epi4.12648. Epub 2022 Oct 20.
This study aimed to evaluate the surgical outcomes and relevant prognostic factors in patients with low-grade epilepsy-associated neuroepithelial tumors (LEAT) and, especially, to develop a scoring system to predict postoperative seizure outcomes.
The clinical data of patients who underwent epilepsy surgery for LEAT were retrospectively studied. The surgical outcomes of seizure and neurological statuses in patients were evaluated using Engel classification and modified Rankin Scale (mRS) scoring, respectively. A scoring system of seizure outcomes was constructed based on the weight of the β-coefficient estimate of each predictor in the final multivariate predicting model of seizure outcomes.
Of the 287 patients (106 female) enrolled, the median age was 19 years at surgery and 10 years at seizure onset, with a median duration of epilepsy of 60 months. Among 258 patients who were followed up for at least 12 months, 215 (83.3%) patients had a favorable seizure outcome (Engel class I) after surgery, and 43 (16.7%) patients had an unfavorable seizure outcome; longer duration of epilepsy, discordant magnetoencephalography (MEG) findings, and acute postoperative seizures were significantly included in the scoring system to predict unfavorable seizure outcomes, and in the scoring system, accumulated scoring of 0-19 scores was recorded, which were finally grouped into three risk levels: low risk (risk < 30%), medium risk (30% ≤ risk < 70%), and high risk (risk ≥ 70%). In addition, favorable neurological outcomes (mRS score 0-1) were recorded in 187 (72.5%) patients, while unfavorable neurological outcomes were recorded in 71 (27.5%) patients, which were significantly related to poor seizure control, older age at surgery, and longer duration of epilepsy and hospitalization time.
The long-term surgical outcomes of LEAT after surgery were satisfactory. A scoring system for predicting unfavorable seizure outcomes with different risk levels was developed, which could partly guide clinical treatments of LEAT.
本研究旨在评估低级别癫痫相关神经上皮肿瘤（LEAT）患者的手术结果和相关预后因素，特别是建立一种评分系统来预测术后癫痫发作结果。
回顾性研究接受 LEAT 癫痫手术的患者的临床资料。采用 Engel 分级和改良 Rankin 量表（mRS）评分分别评估患者的术后癫痫发作和神经功能状态。根据术后癫痫发作结果的最终多变量预测模型中每个预测因子的β系数估计值的权重，构建了一种癫痫发作结果评分系统。
共纳入 287 例患者（106 例女性），手术时的中位年龄为 19 岁，癫痫发病时的中位年龄为 10 岁，癫痫的中位病程为 60 个月。在至少随访 12 个月的 258 例患者中，215 例（83.3%）患者术后癫痫发作结果良好（Engel 分级 I 级），43 例（16.7%）患者癫痫发作结果不佳；较长的癫痫病程、磁源性影像（MEG）结果不一致以及术后急性癫痫发作显著纳入预测不良癫痫发作结果的评分系统，在评分系统中，0-19 分的累积评分记录下来，最终分为三个风险水平：低风险（风险＜30%）、中风险（30%≤风险＜70%）和高风险（风险≥70%）。此外，187 例（72.5%）患者记录到良好的神经功能结局（mRS 评分 0-1），而 71 例（27.5%）患者记录到不良的神经功能结局，与较差的癫痫控制、手术时年龄较大、癫痫病程和住院时间较长显著相关。
LEAT 术后的长期手术结果令人满意。建立了一种具有不同风险水平的预测不良癫痫发作结果的评分系统，该系统可在一定程度上指导 LEAT 的临床治疗。
