伴有丛集发作的儿童癫痫患者的手术治疗

Surgery for children with epilepsy and seizure clustering (report of 33 cases)

目的探讨伴有丛集发作的儿童癫痫患者的手术评估及疗效。方法回顾性分析33例伴有丛集发作的儿童癫痫患者的临床资料,其中缓解性手术治疗8例,切除性手术治疗25例。结果术后随访8~42个月,疗效按Engel分级：缓解性手术治疗患者Ⅱ级2例,Ⅲ级4例,Ⅳ级2例;切除性手术治疗患者Ⅰ级16例,Ⅱ级4例,Ⅲ级3例,Ⅳ级2例。无手术相关永久性并发症发生。结论对于伴有丛集发作的儿童癫痫患者,应尽早进行综合的术前评估并采取相应的手术治疗以获得更好的控制疗效,从而改善患者预后。

Objective To explore the preoperative assessment of children with epilepsy and seizure clustering and the curative effect of surgery on them. Method The clinical data of 33 children with epilepsy and seizure clustering were analyzed retrospectively, including the patient＇s preoperative assessment and following up data and so on. Results The epilepsy children with seizure clustering accounted for 24.3% （33/136） of the children with epilepsy who underwent the surgery from January, 2011 to December, 2013. Of 33 epilepsy children with seizure clustering, 8 underwent palliative surgery （callosotomy） and 25 underwent resection surgery （hemispherectomy, focal resection, part callosotomy and so on）. All the children were followed up from $ to 42 months. According to Engel class, control effect on the epileptic seizures reached Engel class II in 2, class Ⅲ in g and class Ⅳ in 2 in 8 children undergoing the palliative surgery and reached Engel class Ⅰ in 16, class Ⅱ in 4, class Ⅲ in 3 and class Ⅳ in 2 in 25 children undergoing the resection surgery. There was no permanent surgery-related complications occurred in all the children. Conclusions Seizure clustering seriously affects the quality of life in patients with epilepsy. The earlier comprehensive preoperation assessment and surgical management should be recommended to achieve satisfactory control of seizure and good prognoses in the epilepsy children with seizure clustering.