局限性脑皮质发育不良继发癫痫手术及抗癫痫药物疗效分析

Efficacies of surgery and anti-epileptic drugs for refractory epilepsy in focal cortical dysplasia

目的:探讨局限性脑皮质发育不良(focal cortical dysplasia,FCD)患者手术及抗癫痫药物(antiepileptic drugs,AEDS)的疗效和预后的影响因素。方法:筛查2006-2008年在我院因顽固性癫痫而手术的患者,收集病理诊断为FCD的患者临床资料,术后3、6、12个月以及1年以上随访,了解术后癫痫发作情况。结果:共收集FCD癫痫患者17例,病理诊断为ⅠB型5例,ⅡA型6例,ⅡB型6例,平均起病年龄10.01岁,平均病程8.82年,术前使用1～7种AEDS治疗,托吡酯、氯硝安定、卡马西平、拉莫三嗪相对有效,但无法控制发作。术后58.83%(10例)患者可达1年以上无发作。结论:FCD继发的癫痫对AEDS抵抗,外科手术治疗有效,手术边界的确定、病灶的位置、术前诊断以及术后AEDS的管理将影响预后。

Objective To investigate the efficacies of anti-epileptic drugs （AEDS） and surgery for focal cortical dysplasia （FCD） and the prognosis affecting factors. Methods The clinical data of patients with refractory epilepsy who received surgery and who were diagnosed to be with FCD were collected and the patients were followed-up for 1 year to observe the seizures. Results 17 patients （9 males and 8 females） with FCD （9 cases with frontal lobe epilepsy, 6 cases with temporal lobe epilepsy, 1 case with parietal lobe epilepsy and 1 case with occipital lobe epilepsy） were analyzed, including 5 type-ⅠB, 6 type-ⅡA, and 6 type-ⅡB. The mean age of epilepsy onset was 10.01 years, and the mean course of epilepsy was 8.82 years before surgery. No patient was diagnosed pre- operatively to be with FCD according to MR. 1～7 AEDS were used for patients pre-operatively, and topiramate, carbamazepine, clonazepam, and lamotrigine were effective relatively. Of those patients with more than 12 months of follow-up, surgical outcomes were as follows： 58.82% seizure-free for more than one year, 11.76% seizure-free for 6 months, 11.76% seizure-free for 3 months. Conclusions Epilepsy in patients with FCD resists to AEDS, and surgery is effective generally. Determination of operation boundary, lesion location, pre-operative diagnosis and post- operative AEDS management will affect the prognosis.