Berger M S, Ghatan S, Haglund M M, Dobbins J, Ojemann G A
Department of Neurological Surgery, University of Washington School of Medicine, Seattle.
J Neurosurg. 1993 Jul;79(1):62-9. doi: 10.3171/jns.1993.79.1.0062.
Adults and children with low-grade gliomas often present with medically refractory epilepsy. Currently, controversy exists regarding the need for intraoperative electrocorticography (ECoG) to identify and, separately, resect seizure foci versus tumor removal alone to yield maximum seizure control in this patient population. Forty-five patients with low-grade gliomas and intractable epilepsy were retrospectively analyzed with respect to preoperative seizure frequency and duration, number of antiepileptic drugs, intraoperative ECoG data (single versus multiple foci), histology of resected seizure foci, and postoperative control of seizures with or without antiepileptic drugs. Multiple versus single seizure foci were more likely to be associated with a longer preoperative duration of epilepsy. Of the 45 patients studied, 24 were no longer taking antiepileptic drugs and were seizure-free (mean follow-up interval 54 months). Seventeen patients, who all had complete control of their seizures, remained on antiepileptic drugs at lower doses (mean follow-up interval 44 months); seven of these patients were seizure-free postoperatively, yet the referring physician was reluctant to taper the antiepileptic drugs. Four patients continued to have seizures while receiving antiepileptic drugs, although at a reduced frequency and severity. In this series 41% of the adults versus 85% of the children were seizure-free while no longer receiving antiepileptic drugs, with mean postoperative follow-up periods of 50 and 56 months, respectively. This difference was statistically significant (p = 0.016). Therefore, based on this experience and in comparison with numerous retrospective studies involving similar patients, ECoG is advocated, especially in children and in any patient with a long-standing seizure disorder, to maximize seizure control while minimizing or abolishing the need for postoperative antiepileptic drugs.
患有低度恶性胶质瘤的成人和儿童常常伴有药物难治性癫痫。目前，对于在该患者群体中，是否需要术中皮层脑电图（ECoG）来识别并分别切除癫痫病灶，还是仅切除肿瘤以实现最大程度的癫痫控制，存在争议。对45例患有低度恶性胶质瘤和顽固性癫痫的患者进行了回顾性分析，内容包括术前癫痫发作频率和持续时间、抗癫痫药物数量、术中ECoG数据（单病灶与多病灶）、切除的癫痫病灶组织学以及术后使用或不使用抗癫痫药物的癫痫控制情况。多病灶癫痫比单病灶癫痫更可能与术前较长的癫痫持续时间相关。在研究的45例患者中，24例不再服用抗癫痫药物且无癫痫发作（平均随访间隔54个月）。17例患者癫痫完全得到控制，继续服用较低剂量的抗癫痫药物（平均随访间隔44个月）；其中7例患者术后无癫痫发作，但转诊医生不愿减少抗癫痫药物剂量。4例患者在服用抗癫痫药物时仍有癫痫发作，尽管发作频率和严重程度有所降低。在该系列中，41%的成人和85%的儿童在不再服用抗癫痫药物时无癫痫发作，术后平均随访期分别为50个月和56个月。这种差异具有统计学意义（p = 0.016）。因此，基于这一经验并与众多涉及类似患者的回顾性研究相比，提倡使用ECoG，尤其是在儿童以及任何患有长期癫痫疾病的患者中，以最大程度地控制癫痫发作，同时尽量减少或消除术后对抗癫痫药物的需求。
