药物难治性颞叶癫痫术后短期内复发对远期疗效的影响

Influence of relapse of medically intractable temporal lobe epilepsy shortly after surgery in its long-term efficacy

目的探讨药物难治性颞叶癫痫术后短期内复发对远期疗效的影响，为进一步提高颞叶癫痫手术远期疗效提供研究资料。方法回顾性分析郑州大学第五附属医院神经外科自2010年8月至2011年8月收治的57例药物难治性颞叶癫痫患者的临床资料，所有患者均行手术治疗，术后均行门诊或电话定期随访。根据术后1年患者有无癫痫复发，将其分为2组，分别为对照组（未复发，18例），实验组（复发，39例）。对2组患者术后随访资料、术后远期疗效进行对比分析。结果（1）术后颞叶内侧硬化、肿瘤性病变、混合性病变及病理结果正常例数分别为27例、7例、10例及13例，构成比分别为47-37％、12．28％、17．54％及22．81％。（2）术后第2年，实验组癫痫控制满意率为44．44％，显著低于对照组的74．36％，差异有统计学意义（x2=4．839，P=0．028）；（3）Kapan．Meier生存曲线结果显示，对照组术后第2年全年中的癫痫缓解率均显著高于实验组，差异有统计学意义怍5．928，P=-0．017）；（4）多元Logistic回归分析结果显示，复发有诱因（OR=4．511，95％CI1．117～11．958）、复发次数≥3次（OR=4．281，95％C10．040～0．712）及复发癫痫类型以复杂部分性发作／全身强直一阵挛发作为主（OR=3．344，95％CI3．186～8．400）为影响患者远期疗效的危险因素。结论癫痫手术短期内复发对患者远期疗效存在影响，已经明确的因素包括复发有诱因、复发次数及复发类型。

Objective To investigate the influence of drug refractory temporal lobe epilepsy relapse shortly after surgery in its long-term efficacy. Methods The clinical data of 57 patients with medically intractable temporal lobe epilepsy, underwent surgery from August 2010 to August 2011 in our hospital, were retrospectively analyzed; all the patients were performed surgery, and postoperative treatment of epilepsy （adjustment antiepileptic drugs） in our hospital and rehabilitation center was chosen; the parallel regular follow-up clinic or telephone was also performed. According to the relapse situation one year after surgery, these patients were divided into control group （no epilepsy, n=18） and experimental group （relapse, n=39）. Follow-up data, long-term efficacy and overall efficacy between the two groups were analyzed. Results （1） Postoperative medial temporal lobe sclerosis, neoplastic lesions, mixed lesions and normal patients were 27, 7, 10 and 13, respectively, counting for 47.37%, 12.28%, t7.54% and 22.81% of the patients; （2） on the second year of surgery, patients in the experimental group had 44.44% satisfactory seizure control, which was significantly lower than those in the control group （74.36%, X2=4.839, P=0.028）; （3） Kapan-Meier survival curve indicated that epilepsy remission rate in the control group was significantly higher than that in the experimental group on the second year of surgery （x2=5.928, P=0.017）; （4） multivariate Logistic regression analysis showed that risk factors affecting the long-term efficacy included incentives recurrence （OR=4.511, 95%CI： 3.195-7.569）, relapse frequency≥3 times （OR=4.281, 95%CI： 0.040-0.712） and recurrence of epilepsy type to complex partial seizure/generalized tonic-clonic seizures （OR=3.344, 95%CI： 3.186-8.400）. Conclusion Drug refractory temporal lobe epilepsy relapse shortly after surgery will affect its long-term efficacy, and the determinate factors included incentives recurrence, relapse frequency ≥ 3 times and recurrence of epilepsy type.