局灶性脑皮质发育不良致难治性癫痫手术预后影响因素分析

Surgical outcome and prognostic factors in patients with focal cortical dysplasia-related intractable epilepsy

目的 探讨局灶性脑皮质发育不良（focal cortical dysplasia,FCD）致难治性癫痫（intractable epilepsy,IE）手术预后的影响因素。方法 回顾性分析2009年12月至2012年12月新疆医科大学第一附属医院手术的61例FCD致IE的手术效果。应用Logistic回归分析探讨FCD致IE预后的影响因素。结果 本组随访1~3年,术后预后良好（Engel I级）42例,预后不良19例（Ⅱ级10例,Ⅲ级5例,Ⅳ级4例）。Logistic回归分析显示FCD I型、致痫灶未完全切除、脑电图发作间期痫样波（interictal epileptiform discharge,IED）与病灶脑叶不一致为影响预后的独立危险因素,其OR值及95%可信区间分别为5.409[1.171,24.970]、4.760[1.104,20.528]、4.315[1.015,18.349],而年龄、民族、性别、头颅MRI检查结果、致痫灶所在脑叶位置对预后无明显影响。结论 FCDⅡ型、致痫灶完全切除、发作间期痫样波与病灶脑叶一致均与手术预后良好相关。

Objective To analyze the factors affecting the clinical outcomes of surgical operation in patients with focal cortical dysplasia （FCD）-related intractable epilepsy （IE）. Methods We retrospectively analyzed surgical outcomes of 61 patients with FCD-related IE in The First Teaching Hospital of Xinjiang Medical University from December 2009 to December 201：2. Results All cases were followed up for 1-3 years. Forty-two cases （68.8%） were Engel class I, 29 （16.4%） class Ⅱ, 5 （8.2%） class Ⅲ and 4 patients （8.2%） class Ⅳ. Logistic regression showed that FCD type I, incom- plete resection and interictal epileptiform discharge （IED）-lesion mismatch were independent prognostic factors. Age, race, gender, brain MRI and the location of epileptogenic zone were not prognostic factors after surgery in patients with FCD-related IE. Conclusion FCD type Ⅱ, complete resection and IED-lesion match are significantly associated with favorable surgical outcome.