Pediatric Epilepsy Center, Peking University First Hospital, Beijing, China.
CNS Neurosci Ther. 2024 Jan;30(1):e14481. doi: 10.1111/cns.14481. Epub 2023 Oct 3.
To investigate the clinical characteristics, surgical strategy, developmental and seizure outcomes, and predictors of surgical outcome in children with drug-resistant epilepsy (DRE) under 3 years old.
One hundred thirteen consecutive children younger than 3 years of age with DRE underwent curative surgical treatment after multidisciplinary preoperative evaluation using the strategy developed in the pediatric epilepsy center of Peking University First Hospital (PKFHPEC) between 2014 and 2018. These patients were selected for retrospective study. The relevant clinical data were collected and analyzed. The surgical prognoses were classified using the Engel classification, and the developmental assessment results were collected. Statistical analysis of the clinical data was performed to analyze the predictors of seizure outcomes and their correlation with developmental outcomes.
All the patients were followed up for more than 3 years, and 98 (86.7%) patients had no seizure recurrence. One year after surgery, the seizure-free rate was 86.7%, which was as high as that at the last follow-up. Cortical dysplasia was the most frequent etiology of DRE in this cohort, accounting for 77.0%. According to the Engel classification, acute postoperative seizure (APOS; p < 0.001) was a predictor of seizure recurrence. No deaths occurred. No unpredicted long-term severe complications occurred except for one ventricular peritoneal shunt. The patients' neurodevelopmental statuses were improved after successful surgery, while the scores of the pre- and postoperative developmental assessments were closely correlated.
For children who are younger than 3 years old and have DRE and structural abnormalities, early curative treatment can lead to long-term good seizure outcomes and a low complication rate. The development of appropriate strategies for both presurgical evaluation and resection is crucial for the success of surgery.
探讨 3 岁以下耐药性癫痫（DRE）患儿的临床特征、手术策略、发育和癫痫发作结局以及手术结局的预测因素。
2014 年至 2018 年，北京大学第一医院儿科癫痫中心（PKFHPEC）采用多学科术前评估策略，对 113 例 3 岁以下 DRE 患儿进行了根治性手术治疗。对这些患者进行回顾性研究，收集并分析相关临床资料。采用 Engel 分级对手术预后进行分类，收集发育评估结果。对临床资料进行统计学分析，以分析癫痫发作结局的预测因素及其与发育结局的相关性。
所有患者均随访 3 年以上，98 例（86.7%）患者无癫痫复发。术后 1 年癫痫无发作率为 86.7%，与最后一次随访时相同。皮质发育不良是本队列 DRE 最常见的病因，占 77.0%。根据 Engel 分级，急性术后癫痫（APOS；p<0.001）是癫痫复发的预测因素。无死亡病例。除 1 例脑室腹腔分流术外，无意外长期严重并发症发生。成功手术后，患者的神经发育状况得到改善，而术前和术后发育评估的评分密切相关。
对于 3 岁以下且存在结构性异常的 DRE 患儿，早期根治性治疗可获得长期良好的癫痫发作结局和较低的并发症发生率。制定适当的术前评估和切除策略对于手术成功至关重要。
