Wyllie E, Comair Y G, Kotagal P, Bulacio J, Bingaman W, Ruggieri P
Department of Neurology, The Cleveland Clinic Foundation, OH 44195, USA.
Ann Neurol. 1998 Nov;44(5):740-8. doi: 10.1002/ana.410440507.
Few epilepsy surgery outcome data are available from series of pediatric patients. We studied seizure outcome in 136 pediatric patients who had surgery for intractable epilepsy at The Cleveland Clinic between January 1990 and June 1996, with a postoperative follow-up of 1 to 7.5 years (mean, 3.6 years). Sixty-two children (3 months to 12 years old at time of surgery) were compared with 74 adolescents (13-20 years old). Extratemporal or multilobar resections and hemispherectomies were similarly frequent among children (50%) and adolescents (44%), but these procedures strongly predominated in infancy (90% of patients 0-2 years of age). The remaining patients had temporal resection. Cortical dysplasia and low-grade tumor were the most common causes and hippocampal sclerosis was rare. Seizure-free outcome was achieved for 69% of adolescents, 68% of children, and 60% of the infant subgroup, overall; for 23 (74%) of 31 children and 33 (80%) of 41 adolescents after temporal resection; for 11 (58%) of 19 children and 15 (52%) of 29 adolescents after extratemporal or multilobar resection; and for 8 (67%) of 12 children and 3 (75%) of 4 adolescents after functional hemispherectomy. Seizure-free outcome was more frequent after temporal resection (56 of 72, 78%) than after extratemporal or multilobar resection (26 of 48, 54%; 41 of 48 with a focal lesion on magnetic resonance imaging), and among patients with tumor (36 of 44, 82%) versus cortical dysplasia (16 of 31, 52%). The frequency of seizure-free outcome after epilepsy surgery was similar for infants, children, and adolescents, and comparable with results from adult series. Most patients in each age, surgery type, and causal group were free from seizures after surgery. These results suggest that children should be considered for surgical evaluation at whatever age they manifest with severe, intractable, disabling localization-related epilepsy.
关于小儿患者癫痫手术疗效的数据很少。我们研究了1990年1月至1996年6月在克利夫兰诊所接受难治性癫痫手术的136例小儿患者的癫痫发作情况，术后随访1至7.5年（平均3.6年）。将62名儿童（手术时年龄3个月至12岁）与74名青少年（13 - 20岁）进行比较。儿童（50%）和青少年（44%）中颞叶外或多叶切除及大脑半球切除术的频率相似，但这些手术在婴儿期（0 - 2岁患者的90%）中占主导地位。其余患者接受颞叶切除术。皮质发育异常和低级肿瘤是最常见的病因，海马硬化很少见。总体而言，69%的青少年、68%的儿童和60%的婴儿亚组实现了无癫痫发作；31名儿童中的23名（74%）和41名青少年中的33名（80%）在颞叶切除术后实现了无癫痫发作；19名儿童中的11名（58%）和29名青少年中的15名（52%）在颞叶外或多叶切除术后实现了无癫痫发作；12名儿童中的8名（67%）和4名青少年中的3名（75%）在功能性大脑半球切除术后实现了无癫痫发作。无癫痫发作的结果在颞叶切除术后（72例中的56例，78%）比在颞叶外或多叶切除术后（48例中的26例，54%；磁共振成像有局灶性病变的48例中的41例）更常见，在肿瘤患者（44例中的36例，82%）中比在皮质发育异常患者（31例中的16例，52%）中更常见。癫痫手术后无癫痫发作结果在婴儿、儿童和青少年中的频率相似，且与成人系列的结果相当。各年龄、手术类型和病因组中的大多数患者术后无癫痫发作。这些结果表明，无论儿童在何年龄出现严重、难治性、致残性局灶性相关癫痫，都应考虑进行手术评估。
