脑动静脉畸形相关癫痫的立体定向放射外科治疗：一项国际多中心研究。
Epilepsy associated with cerebral cavernous malformations managed with stereotactic radiosurgery: an international, multicenter study.
机构信息
Department of Neurological Surgery, University of Virginia, 1215 Lee St, Charlottesville, VA, 22908, USA.
Department of Neurological Surgery, Hospices Civils de Lyon, Lyon, France.
出版信息
J Neurol. 2023 Oct;270(10):5048-5056. doi: 10.1007/s00415-023-11836-6. Epub 2023 Jul 5.
OBJECTIVE
Stereotactic radiosurgery (SRS) has been proposed as an alternative to resection for epilepsy control in patients with cerebral cavernous malformations (CCM) located in critical areas.
METHODS
This multicentric, retrospective study evaluated seizure control in patients with a solitary CCM and a history of at least one seizure prior to SRS.
RESULTS
109 patients (median age at diagnosis 28.9 years, interquartile range (IQR) 16.4 years] were included. Prior to SRS, 2 (1.8%) were seizure-free without medication, 35 (32.1%) were seizure-free with antiseizure medications (ASM), 17 (15.6%) experienced an improvement of at least 50% in seizure frequency/intensity with ASM, and 55 (50.5%) experienced an improvement of less than 50% in seizure frequency/intensity with ASM. At a median follow-up of 3.5 years post-SRS (IQR: 4.9), 52 (47.7%) patients were Engel class I, 13 (11.9%) class II, 17 (15.6%) class III, 22 (20.2%) class IVA or IVB and 5 (4.6%) class IVC. For the 72 patients who had seizures despite medication prior to SRS, a delay > 1.5 years between epilepsy presentation and SRS decreased the probability to become seizure-free, HR 0.25 (95% CI 0.09-0.66), p = 0.006. The probability of achieving Engel I at the last follow-up was 23.6 (95% CI 12.7-33.1) and 31.3% (95% CI 19.3-50.8) at 2 and 5 years respectively. 27 patients were considered as having drug-resistant epilepsy. At a median follow-up of 3.1 years (IQR: 4.7), 6 (22.2%) of them were Engel I, 3 (11.1%) Engel II, 7 (25.9%) Engel III, 8 (29.6%) Engel IVA or IVB and 3 (11.1%) Engel IVC.
INTERPRETATION
47.7% of patients managed with SRS for solitary CCM presenting with seizures achieved Engel class I at the last follow-up.
目的
立体定向放射外科（SRS）已被提议作为切除手术的替代方法，用于控制位于关键区域的脑海绵状血管畸形（CCM）患者的癫痫发作。
方法
这项多中心回顾性研究评估了 SRS 前有单一 CCM 且至少有一次癫痫发作史的患者的癫痫发作控制情况。
结果
共纳入 109 例患者（中位诊断年龄为 28.9 岁，四分位距[IQR]为 16.4 岁）。SRS 前，2 例（1.8%）无药物治疗即无癫痫发作，35 例（32.1%）无药物治疗即无癫痫发作，17 例（15.6%）抗癫痫药物（ASM）治疗后癫痫发作频率/强度至少改善 50%，55 例（50.5%）ASM 治疗后癫痫发作频率/强度改善小于 50%。SRS 后中位随访 3.5 年（IQR：4.9），52 例（47.7%）患者为 Engel Ⅰ级，13 例（11.9%）为 Engel Ⅱ级，17 例（15.6%）为 Engel Ⅲ级，22 例（20.2%）为 Engel Ⅳ A 或 Ⅳ B 级，5 例（4.6%）为 Engel Ⅳ C 级。对于 SRS 前尽管药物治疗仍有癫痫发作的 72 例患者，癫痫发作出现到 SRS 的时间延迟超过 1.5 年，使无癫痫发作的可能性降低，HR 0.25（95%CI 0.09-0.66），p=0.006。最后一次随访时达到 Engel I 的概率为 23.6%（95%CI 12.7-33.1），2 年和 5 年时分别为 31.3%（95%CI 19.3-50.8）。27 例患者被认为患有耐药性癫痫。在中位随访 3.1 年（IQR：4.7）时，其中 6 例（22.2%）为 Engel I 级，3 例（11.1%）为 Engel II 级，7 例（25.9%）为 Engel III 级，8 例（29.6%）为 Engel IV A 或 IV B 级，3 例（11.1%）为 Engel IV C 级。
结论
47.7%的 SRS 治疗孤立性 CCM 伴癫痫发作的患者在最后一次随访时达到 Engel I 级。
Zotero 插件