药物难治性癫痫89例术前评估适应证再探讨

Further Discussion of Pre-surgery Evaluation Indications for Drug-resistant Epilepsy:Report of 89 cases

目的探讨药物难治性癫痫术前评估适应证失败原因分析。方法回顾性分析89例癫痫术前评估后未做手术患者的年龄、病程、既往史、发作症状、颅脑磁共振、发作间期和发作期脑电图等特点,综合分析非手术原因。结果癫痫患者术前评估后非手术的原因依次为:患者及家属因多种原因放弃颅内电极定位(39/89,43.8%),致痫灶弥散、多灶(27/89,30.3%),全面性发作(14/89,15.7%),致痫灶位于功能区(6/89,6.7%)及遗传代谢性脑病(3/89,3.4%)。结论既往患重症病毒性脑炎和围生期脑损伤,和(或)颅脑MRI呈弥散、多发、双侧异常者,致痫灶多弥散或多灶,手术可能性较小。辨别全面性发作及进行性脑部疾病可避免不必要的术前评估。目前患者及家属仍对手术风险、费用及效果存有疑虑,告知其手术的风险与获益,非常重要。

Objective To investigate the reasons for failures of pre-operative evaluation indications for drug-resistant epilepsy.Methods A retrospective analysis was conducted on age,disease duration,past history,onset symptoms,cranial MRI,interictal and ictal EEG of 89 epilepsy patients not having operation after pre-operative evaluation.The reasons were analyzed comprehensively.Results The reasons for not having operations after pre-operative evaluation were：patients and their families giving up intracranial electrode positioning for various reasons （39/89,43.8%）,diffuse epileptogenic focus,multiple focus （27/89,30.3%）,generalized seizures （14/89,15.7%）,epileptic foci in functional areas （6/89,6.7%） and genetic metabolic encephalopathy （3/89,3.4%）.Conclusion Patients with past severe viral encephalitis and perinatal brain injury,and （or） cranial MRI showing diffuse,multiple,bilateral abnormalities or multi-diffuse epileptogenic focus or multi-focus have little probability of operation.Identification of generalized seizures and progressive brain diseases can avoid unnecessary pre-operative evaluation.Since patients and their families doubt about surgery risk,costs and effects,it is important to tell them the risks and benefits of operation.