Department of Neurosurgery and Clinical Research Center for Refractory Epilepsy of Shaanxi Province, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an 710061, Shaanxi, China.
Center of Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.
Neurosurg Rev. 2023 Apr 18;46(1):89. doi: 10.1007/s10143-023-01988-4.
The predictors of seizure outcomes after resective surgery for focal epilepsy, for an update on the features of good and poor outcomes, are investigated. A retrospective study of patients with focal epilepsy undergoing resective surgery from March 2011 to April 2019 was performed. There were 3 groups according to the seizure outcomes: seizure freedom, seizure improvement, and no improvement. Predictors of seizure outcomes were identified by multivariate logistic regression analysis. Of all 833 patients, 561 (67.3%) patients remained seizure-free at the last follow-up, 203 (24.4%) patients had seizure improvement, and 69 (8.3%) had no improvement. The mean follow-up duration was 5.2 years (range: 2.7 to 9.6). Predictors of better outcomes included epilepsy duration < 5 years, localized discharge, no. of antiepileptic drugs at surgery < 3, and temporal lobe resection. However, predictors of worse outcomes included intracranial hemorrhage in infancy, interictal abnormal discharge, intracranial electrode monitoring, and acute postoperative seizure. Our study suggests that resective surgery for focal epilepsy has satisfactory outcomes. Short epilepsy duration, localized discharge, and temporal lobe resection are positive predictors of seizure freedom. Patients with these predictors are intensively recommended for surgery.
本研究旨在探讨预测局灶性癫痫患者切除术后癫痫发作结局的因素，更新预后良好和不良的特征。回顾性分析 2011 年 3 月至 2019 年 4 月期间行切除术的局灶性癫痫患者。根据术后发作结局分为 3 组：无发作、发作改善和无改善。采用多变量逻辑回归分析确定预测因素。833 例患者中，561 例（67.3%）患者在末次随访时无发作，203 例（24.4%）患者发作改善，69 例（8.3%）患者无改善。平均随访时间为 5.2 年（范围：2.7-9.6 年）。更好结局的预测因素包括癫痫持续时间＜5 年、局限性放电、手术时抗癫痫药物数量＜3 种和颞叶切除术。然而，更差结局的预测因素包括婴儿期颅内出血、发作间期异常放电、颅内电极监测和术后急性发作。本研究表明，局灶性癫痫的切除术有较好的结局。癫痫持续时间短、局限性放电和颞叶切除术是无发作的阳性预测因素。具有这些预测因素的患者强烈建议手术。
