Yang Menghan, Zhang Yingying, Zhang Tianyu, Zhou Huanyu, Ren Jiechuan, Cao Xiaojing, Zhou Dong, Yang Tianhua
Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China.
Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China.
Epilepsy Behav. 2024 Dec;161:110056. doi: 10.1016/j.yebeh.2024.110056. Epub 2024 Sep 21.
Analyze the association between histopathology, seizure outcomes, and drug load of antiseizure medications (ASMs) 5-8 years after epilepsy surgery to inform preoperative decision-making and consultation.
In this retrospective, non-interventional, single-center study, patients who visited the epilepsy clinic at West China Hospital, Sichuan University from Jan 1, 2015 to Dec 31, 2020 were assessed. Patients with postoperative histopathology after epilepsy resection were included and categorized into 13 etiological groups. The primary outcomes were achieving Engel class 1 at 1, 2, 3, 5, and 8 years postoperative. Secondary outcomes included the use of ASMs and comparison of postoperative seizure outcomes between adults and children. Univariate and multivariable analyses were conducted to explore the association between clinical characteristics such as histopathology and seizure outcomes.
A total of 315 patients were include. Patients with embryonic dysplastic neuroepithelial tumor (DNT) achieved the best seizure outcomes (84.6 % Engel class 1). DNT (odds ratio, OR=0.103, 95 %CI=0.012-0.899), cavernous hemangiomas (OR=0.140, 95 %CI=0.024-0.819) and meningioma (OR=0.137, 95 %CI=0.021-0.910) were independently associated with a higher probability of seizure-free outcome. The results of epileptic seizures in adult and pediatric groups with different pathologies were significantly different, and the preoperative and postoperative ASM dosages were also different among adult patients with various etiologies. Additionally, multivariate analysis showed that early age at onset (adjusted hazard ratio (HR) = 1.754, 95 % CI=1.049-2.934, P=0.032), late surgical age (HR=0.569, 95 %CI=0.339-0.954, P=0.032), and longer duration from seizure onset to surgery (HR=1.735, 95 % CI=1.028-2.928, P=0.039) were independent predictors of unfavorable outcomes in epileptic seizures.
we demonstrated that the seizure outcomes of focal epilepsy have high pathological specificity, with histopathological diagnosis serving as a crucial and independent determinant of seizure outcome. Surgical assessment should be contemplated for all patients with presumed refractory focal epilepsy, irrespective of their age.
分析癫痫手术后5 - 8年组织病理学、癫痫发作结局与抗癫痫药物（ASM）药物负荷之间的关联，为术前决策和咨询提供依据。
在这项回顾性、非干预性、单中心研究中，对2015年1月1日至2020年12月31日期间到四川大学华西医院癫痫门诊就诊的患者进行评估。纳入癫痫切除术后有组织病理学结果的患者，并将其分为13个病因组。主要结局为术后1年、2年、3年、5年和8年达到恩格尔1级。次要结局包括ASM的使用情况以及成人与儿童术后癫痫发作结局的比较。进行单因素和多因素分析以探讨组织病理学等临床特征与癫痫发作结局之间的关联。
共纳入315例患者。胚胎发育不良性神经上皮肿瘤（DNT）患者的癫痫发作结局最佳（84.6%为恩格尔1级）。DNT（优势比，OR = 0.103，95%可信区间[CI] = 0.012 - 0.899）、海绵状血管瘤（OR = 0.140，95%CI = 0.024 - 0.819）和脑膜瘤（OR = 0.137，95%CI = 0.021 - 0.910）与无癫痫发作结局的较高概率独立相关。不同病理类型的成人和儿童组癫痫发作结果有显著差异，不同病因的成年患者术前和术后ASM剂量也不同。此外，多因素分析显示发病年龄早（调整后风险比[HR] = 1.754，95%CI = 1.049 - 2.934，P = 0.032）、手术年龄晚（HR = 0.569，95%CI = 0.339 - 0.954，P = 0.032）以及从癫痫发作开始到手术的时间较长（HR = 1.735，95%CI = 1.028 - 2.928，P = 0.039）是癫痫发作不良结局的独立预测因素。
我们证明局灶性癫痫的发作结局具有高度病理特异性，组织病理学诊断是发作结局的关键且独立的决定因素。对于所有推测为难治性局灶性癫痫的患者，无论其年龄大小，都应考虑进行手术评估。
