放射外科手术后与脑动静脉畸形相关的癫痫控制
Control of epilepsy associated with cerebral arteriovenous malformations after radiosurgery.
作者信息
Kurita H, Kawamoto S, Suzuki I, Sasaki T, Tago M, Terahara A, Kirino T
机构信息
Department of Neurosurgery, Faculty of Medicine, University of Tokyo, Japan.
出版信息
J Neurol Neurosurg Psychiatry. 1998 Nov;65(5):648-55. doi: 10.1136/jnnp.65.5.648.
OBJECTIVE
To investigate the effect of radiosurgery for symptomatic epilepsy associated with cerebral arteriovenous malformations (AVMs).
METHODS
Thirty five patients with unruptured epileptogenic AVMs were studied with a mean follow up of 43.0 months. The duration of epilepsy before radiosurgery ranged from 2 months to 21 years (mean 2.8 years). Fifteen patients showed partial seizures; eight of these had associated secondary generalisation. The remaining 20 patients showed only generalised seizures without preceding focal seizures.
RESULTS
At the final follow up examination, 28 patients remained seizure free, whereas seizures continued in seven. Variables significantly associated with continuity of seizures after radiosurgery were the number of seizures before therapy (p<0.01) and duration of epilepsy (p<0.05). According to Engel's classification, the 10 patients with intractable seizures before treatment included five with grade I, four with grade III, and one with grade IV. The frequency of seizures began to decrease several months after radiosurgery; much shorter than the time required for morphological change in the AVMs.
CONCLUSIONS
Radiosurgery seems to be beneficial for seizure control in patients with unruptured epileptogenic AVM.
目的
探讨放射外科手术治疗与脑动静脉畸形（AVM）相关的症状性癫痫的效果。
方法
对35例未破裂的致痫性AVM患者进行研究，平均随访43.0个月。放射外科手术前癫痫发作的持续时间为2个月至21年（平均2.8年）。15例患者表现为部分性发作；其中8例伴有继发性全面性发作。其余20例患者仅表现为全面性发作，无前兆局灶性发作。
结果
在最后一次随访检查时，28例患者无癫痫发作，而7例患者仍有癫痫发作。与放射外科手术后癫痫发作持续相关的显著变量是治疗前癫痫发作的次数（p<0.01）和癫痫持续时间（p<0.05）。根据Engel分类，治疗前10例难治性癫痫患者中，5例为I级，4例为III级，1例为IV级。癫痫发作频率在放射外科手术后几个月开始下降；比AVM形态学改变所需的时间短得多。
结论
放射外科手术似乎有利于未破裂的致痫性AVM患者控制癫痫发作。
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