Oliveira Ana Valeria Duarte, Machado Hélio Rubens, Thomé Úrsula, Santos Marcelo Volpon, de Angelis Geisa, Leite João Pereira, Dos Santos Antonio Carlos, Wichert-Ana Lauro, Hamad Ana Paula, Sakamoto Américo Ceiki, Rodrigues Velasco Tonicarlo
Center for Pediatric Epilepsy Surgery, University Hospital, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.
Division of Pediatric Neurosurgery, Ribeirão Prêto Medical School, University of São Paulo, Ribeirão Preto, Brazil.
Epilepsia. 2025 Aug;66(8):2703-2714. doi: 10.1111/epi.18437. Epub 2025 Apr 29.
This study was undertaken to assess the impact of surgical treatment on the adaptive abilities of children with drug-resistant epilepsy (DRE) and moderate or severe developmental delays, and to identify factors that could potentially predict adaptive outcomes following epilepsy surgery.
A retrospective observational cohort study was conducted involving 130 pediatric patients with DRE treated in the Ribeirão Preto Epilepsy Surgery Program of the University of São Paulo between 1996 and 2019. Patients underwent comprehensive preoperative evaluations, including neurological, psychiatric, social, and neuropsychological assessments using the Vineland Adaptive Behavior Scale. Adaptive functioning was assessed at three time points: before surgery and approximately 15 months and 34 months after surgery. Seizure outcomes were classified using the Engel scale. Statistical analyses included analysis of variance, Spearman correlation, and general linear model for repeated measures.
Before surgery, patients exhibited severe adaptive delays, with an average age equivalence (AE) of 18.2 months compared to an average chronological age of 78 months. Postoperatively, significant improvements in AE were observed, particularly among patients who achieved seizure freedom (Engel class I). At the first postoperative evaluation (median of 15 months after surgery), the average AE increased to 24.1 months (p < .01). At the second postoperative evaluation (median of 34 months after surgery), the average AE further increased to 27.5 months. Seizure-free patients demonstrated greater improvements in adaptive skills compared to those who continued to experience seizures (F = 5.845, p = .018) SIGNIFICANCE: This study reinforces that epilepsy surgery can lead to significant adaptive improvements in children with DRE, including those with severe neurological impairments. The findings highlight the positive impact of seizure freedom on developmental progress and underscore the importance of early intervention to minimize adaptive delays.
本研究旨在评估手术治疗对耐药性癫痫（DRE）且伴有中度或重度发育迟缓儿童适应能力的影响，并确定可能预测癫痫手术后适应结果的因素。
进行了一项回顾性观察队列研究，纳入了1996年至2019年间在圣保罗大学里贝朗普雷图癫痫手术项目中接受治疗的130例小儿DRE患者。患者接受了全面的术前评估，包括使用文兰适应行为量表进行神经、精神、社会和神经心理学评估。在三个时间点评估适应功能：手术前、手术后约15个月和34个月。使用恩格尔量表对癫痫发作结果进行分类。统计分析包括方差分析、Spearman相关性分析和重复测量的一般线性模型。
手术前，患者表现出严重的适应延迟，平均年龄当量（AE）为18.2个月，而实际年龄平均为78个月。术后，观察到AE有显著改善，尤其是在实现无癫痫发作（恩格尔I级）的患者中。在首次术后评估（手术后中位数为15个月）时，平均AE增加到24.1个月（p <.01）。在第二次术后评估（手术后中位数为34个月）时，平均AE进一步增加到27.5个月。与仍有癫痫发作的患者相比，无癫痫发作的患者在适应技能方面有更大的改善（F = 5.845，p = 0.018）。
本研究强化了癫痫手术可使DRE儿童，包括那些有严重神经损伤的儿童，在适应能力方面有显著改善。研究结果突出了无癫痫发作对发育进展的积极影响，并强调了早期干预以尽量减少适应延迟的重要性。
