立体定向脑电图（SEEG）引导下射频热凝术（RF-TC）治疗儿童药物难治性癫痫的疗效与安全性：一项回顾性分析

Efficacy and safety of stereoelectroencephalography (SEEG)-guided radiofrequency thermocoagulation (RF-TC) in the treatment of paediatric drug-resistant epilepsy: A retrospective analysis.

作者信息

Xie Zihang, Zhang Shuxin, Deng Jie, Chen Shuai, Li Hua, Meng Fangang, Fang Tie

机构信息

Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.

Department of Functional Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.

出版信息

Folia Neuropathol. 2024 Aug 21. doi: 10.5114/fn.2024.136413.

DOI:10.5114/fn.2024.136413

PMID:39165210

Abstract

INTRODUCTION

This investigation evaluates the effectiveness and safety of stereoelectroencephalography (SEEG)-guided radiofrequency thermocoagulation (RF-TC) as a treatment modality for drug-resistant epilepsy.

MATERIAL AND METHODS

A retrospective review of clinical data from 40 paediatric patients with drug-resistant epilepsy, who underwent SEEG-guided RF-TC at our Epilepsy Center between 2020 and 2022, was conducted. This review included the patients' medical history, imaging and electroencephalography results, surgical procedures, and follow-up outcomes.

RESULTS

The duration of SEEG monitoring, accompanied by concurrent electrical stimulation tests, varied from 3 days to 4 weeks. Following RF-TC surgery, 4 patients demonstrated temporary neurological impairments, including central facial and tongue weakness, reduced limb strength, and challenges in fine motor hand movements. All these symptoms were related to lesions in the central region, but showed improvement within 2 weeks to 3 months post-surgery. There were no reported instances of status epilepticus, intracranial haemorrhage, or infections. During a follow-up period of 6 months to 2.5 years, seizure control was achieved in 25 patients (62.5%) at 6 months post-surgery, and a > 50% decrease in seizure frequency was observed in 10 patients. In 5 patients where seizure control was not achieved, the management of epilepsy seemed to be independent of factors such as age at surgery, duration of preoperative disease, seizure type, or negative MRI findings ( p > 0.05). Patients with controlled epilepsy exhibited cognitive improvement, with some demonstrating no EEG abnormalities upon follow-up and a decrease in antiepileptic medication.

CONCLUSIONS

SEEG-guided RF-TC appears to be a potentially effective and safe therapeutic approach for paediatric patients with drug-resistant epilepsy.

摘要

引言

本研究评估立体定向脑电图（SEEG）引导下的射频热凝术（RF-TC）作为耐药性癫痫治疗方式的有效性和安全性。

材料与方法

对2020年至2022年期间在我们癫痫中心接受SEEG引导下RF-TC治疗的40例耐药性癫痫患儿的临床资料进行回顾性分析。该回顾包括患者的病史、影像学和脑电图结果、手术过程及随访结果。

结果

SEEG监测时长（同时进行电刺激测试）从3天到4周不等。RF-TC手术后，4例患者出现暂时性神经功能障碍，包括中枢性面瘫和舌肌无力、肢体力量减弱以及手部精细运动困难。所有这些症状均与中央区病变有关，但在术后2周内至3个月有所改善。未报告癫痫持续状态、颅内出血或感染病例。在6个月至2.5年的随访期内，25例患者（62.5%）在术后6个月实现癫痫控制，10例患者癫痫发作频率降低超过50%。在5例未实现癫痫控制的患者中，癫痫的管理似乎与手术年龄、术前病程、癫痫发作类型或MRI阴性结果等因素无关（p>0.05）。癫痫得到控制的患者认知功能有所改善，部分患者随访时脑电图无异常且抗癫痫药物用量减少。