Division of Pediatric Neurology, Department of Neurology, Seattle Children's Hospital, University of Washington, Seattle, Washington, USA.
Department of Clinical Analytics, Seattle Children's Hospital, Seattle, Washington, USA.
World Neurosurg. 2022 Nov;167:e1154-e1162. doi: 10.1016/j.wneu.2022.08.138. Epub 2022 Sep 6.
The seizure outcomes after hemispheric epilepsy surgery have been excellent, with 54%-90% of patients achieving long-term freedom from seizures. Similarly, the neuropsychological outcomes have been favorable. The prognostic value of pre- and postoperative electroencephalography (EEG) has not been well-studied. In the present study, we characterized the value of the pre- and postoperative EEG findings for predicting the seizure and neuropsychological outcomes for pediatric patients undergoing hemispherectomy.
A total of 22 children who had undergone functional hemispherectomy at our institution from 2010 to 2020 were included. The ictal and interictal findings were categorized as ipsilateral to the operated hemisphere, independently arising from the contralateral hemisphere, and/or generalized. The seizure outcomes were classified using the Engel scale. All neuropsychological evaluations were performed in accordance with our institution's protocol. The relationship between the EEG findings and outcomes was analyzed.
Of the 22 patients, 19 (86%) were seizure free (Engel class IA) at the latest follow-up (mean, 4.2 years). On the preoperative EEGs, 9 had had seizures, all had had ipsilateral interictal discharges, and 9 had had contralateral interictal discharges. On the postoperative EEGs, obtained a median of 1 year after surgery, 3 had had seizures, 16 had had ipsilateral interictal discharges, and 5 had had contralateral interictal discharges. Of the 3 patients with seizures found on the postoperative EEG, all were clinically free of seizures. The patients who had not achieved Engel class IA were not significantly more likely to have abnormalities found on the EEG. The neuropsychological scores were stable from before to after surgery, with no evidence of EEG abnormalities having predictive value.
The seizure and neuropsychology outcomes after hemispherectomy were excellent in our study, with 86% of our cohort achieving freedom from seizures. The presence, lateralization, and evolution of pre- and postoperative EEG abnormalities were not predictive of the outcomes.
半球性癫痫手术后的癫痫发作结果一直很好，54%-90%的患者长期无癫痫发作。同样，神经心理学结果也很好。术前和术后脑电图（EEG）的预后价值尚未得到很好的研究。在本研究中，我们描述了术前和术后 EEG 结果对预测行半球切除术的儿科患者癫痫发作和神经心理学结果的价值。
共纳入 2010 年至 2020 年期间在我院行功能性半球切除术的 22 例儿童。将发作期和发作间期的发现分为手术对侧半球同侧、独立于对侧半球起源和/或全身性。采用 Engel 量表对癫痫发作结果进行分类。所有神经心理学评估均按照我院的方案进行。分析 EEG 发现与结局的关系。
22 例患者中，19 例（86%）在最近的随访（平均 4.2 年）时无癫痫发作（Engel 分级 IA）。术前 EEG 中，9 例有癫痫发作，均有同侧发作间期放电，9 例有对侧发作间期放电。术后 EEG 在术后中位数 1 年获得，3 例有癫痫发作，16 例有同侧发作间期放电，5 例有对侧发作间期放电。术后 EEG 发现的 3 例癫痫发作患者均无临床癫痫发作。未达到 Engel 分级 IA 的患者 EEG 异常的可能性无显著差异。神经心理学评分在手术前后稳定，无 EEG 异常的证据具有预测价值。
在本研究中，半球切除术的癫痫发作和神经心理学结果非常好，我们的队列中有 86%的患者无癫痫发作。术前和术后 EEG 异常的存在、侧化和演变与结果无相关性。
