成人幕上脑胶质母细胞瘤术后癫疒间发作的预防

Postoperative seizure prophylaxis in adults with supratentorial glioblastoma multiforme

目的探讨成人幕上脑胶质母细胞瘤（GBM）术后预防性应用抗癫癎药物对癫癎发作的影响。方法回顾性分析86例术前无癫癎发作的幕上GBM病例资料，根据病人术后预防性应用抗癫癎药物情况分为对照组（不使用抗癫癎药物）、研究1组（使用抗癫癎药物4周）和研究2组（使用抗癫癎药物24周），统计术后癫癎发作情况和术后24周各组Karnofsky评分。结果术后4周内出现癫癎发作对照组5例（16．7％），研究组1例（1．8％），两组癫癎发作有显著性差异（P〈0．05）。术后5～24周新发癫癎发作对照组7例（23．3％）．研究1组7例（25．0％），研究2组1例（3．6％），研究2组新发癫癎发作屁著低于对照组和研究1组（P〈0．05）。研究2组术后24周Karnofsky评分为66．96±10．30，明显高于对照组和研究1组（P〈0．05）。结论预防性应用抗癫癎药物可减少GBM术后癫癎发作发病率，术后癫癎发作治疗困难且影响生活质量，术后预防性应用抗癫癎药物应当不少于24周。

Objective To explore effect of prophylactic antiepileptic drugs on postoperative seizure in adults with supratentorial glioblastoma multiforme （GBM）. Methods Clinical data of 86 patients with supratemorial GBM who had no seizures before operation were analyzed retrospectively. According to the prophylactic application of antiepileptic drugs after GBM resection, the patients were divided into control group （without antiepileptic drugs）, first test group （with antiepileptic drugs for 4 weeks）, and second test group （with antiepileptic drugs for 24 weeks）. The epileptic seizures of the patients after the surgery and Kamofsky score were counted. Results There were 5 patients （16.7%） in control group and one patient （1.8%） in test group suffering seizures of epilepsy in 4 week after tumor resection, the difference was significant between control group and test group （P 〈 0.05）. During 5-24 weeks after the operation, one patient （3.6%） in the second test group, 7 patients （28.0%） in the control group and 7 （25.9%） in the first test group suffered new onset of seizure, and the incidence of new seizure onset was significant lower in the second test group than in the other groups （P 〈 0.05）. Karnofsky score was 66.96 ± 10.30 at 24 weeks after the operation in the second test group, which was significant higher than that in the other groups （P 〈 0.05）. Conclusions Prophylactic using of anti-epilepsy drugs could reduce incidence of postoperative seizure in patients undergoing GBM resections. The postoperative seizure onset is poor response to anti-epilepsy drugs and has obvious influence on performance score, and prophylactic application ofantiepileptic drugs for postoperative seizure onset should be not less than 24 weeks in adults with GBM.