Sperling M R, O'Connor M J, Saykin A J, Plummer C
Comprehensive Epilepsy Center, Graduate Hospital, Philadelphia, PA 19146, USA.
JAMA. 1996 Aug 14;276(6):470-5.
To examine the long-term effectiveness of anterior temporal lobectomy for refractory epilepsy with regard to seizure control and related medical and psychosocial measures and to determine how patterns of early seizure recurrence relate to long-term prognosis.
A cohort of patients prospectively followed up for 5 years after surgery.
Tertiary care comprehensive epilepsy center.
Eighty-nine patients with medically refractory epilepsy who were consecutively treated with anterior temporal lobectomy between 1986 and 1990. All patients had noninvasive preoperative evaluations, and 31 were evaluated with intracranial electrodes prior to surgery.
Postoperative seizure frequency, neuropsychologic function, mortality, and postoperative employment status.
Five years after surgery, 62 patients (70 percent) were seizure free, 8 (9 percent) had seizures on fewer than 3 days per year or exclusively had nocturnal seizures, 10 (11 percent) had greater than 80 percent reduction in seizure frequency, 5 (6 percent) had less than 80 percent reduction in seizure frequency, and 4 (4 percent) died of causes unrelated to surgery. The proportion of patients in each outcome class remained stable throughout the 5-year period. Fifty-five percent of seizure recurrences happened within 6 months of surgery, and 93 percent occurred within 2 years after surgery. Outcome at 1 year related only moderately well to outcome at 5 years. No significant cognitive or linguistic deficits occurred. All patients who died had persistent seizures after surgery. Underemployment and unemployment declined significantly after surgery, with improvement noted in seizure-free patients.
Temporal lobectomy provides sustained seizure relief over 5 years to most patients who have surgery. Outcome at 2 years predicts long-term outcome. A seizure-free state is associated with reduced mortality and increased employment. Mere reduction in seizure frequency is not associated with improvement in those measures.
探讨前颞叶切除术治疗难治性癫痫在控制癫痫发作以及相关医学和社会心理指标方面的长期疗效，并确定早期癫痫复发模式与长期预后的关系。
一组患者术后进行了为期5年的前瞻性随访。
三级医疗综合癫痫中心。
1986年至1990年间连续接受前颞叶切除术治疗的89例药物难治性癫痫患者。所有患者术前均进行了无创评估，31例患者术前还接受了颅内电极评估。
术后癫痫发作频率、神经心理功能、死亡率和术后就业状况。
术后5年，62例患者（70%）无癫痫发作，8例（9%）每年癫痫发作少于3天或仅在夜间发作，10例（11%）癫痫发作频率降低超过80%，5例（6%）癫痫发作频率降低不足80%，4例（4%）死于与手术无关的原因。在整个5年期间，每个结局类别中的患者比例保持稳定。55%的癫痫复发发生在术后6个月内，93%发生在术后2年内。1年时的结局与5年时的结局仅中度相关。未出现明显的认知或语言缺陷。所有死亡患者术后均有持续性癫痫发作。术后就业不足和失业情况显著下降，无癫痫发作的患者有改善。
颞叶切除术为大多数接受手术的患者提供了长达5年的持续癫痫缓解。2年时的结局可预测长期结局。无癫痫发作状态与死亡率降低和就业增加相关。单纯癫痫发作频率降低与这些指标的改善无关。
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