难治性颞叶癫痫术后急性发作对远期预后的预测价值

Long-term prognostic value of acute postoperative seizures in patients with refractory temporal lobe epilepsy

目的探讨药物难治性颞叶癫痫术后急性发作对远期预后的影响。方法回顾性分析我院自2009年6月-2010年6月收治的52例药物难治性颞叶癫痫患者的临床资料,所有患者均接受外科治疗,术后定期门诊或电话随访。根据术后7天患者有无急性发作,分为2组,分为实验组(复发),对照组(未复发)。将2组患者随访资料、远期预后(5年)等进行对比分析。结果实验组癫痫控制满意率为35.0%,对照组控制满意率为68.8%,实验组明显低于对照组,差异有统计学意义(χ2=5.683,P=0.017)。在多元Logistic回归分析结果中,复发次数、术前使用抗癫痫药物数量、术后脑电图,术后急性发作与术前习惯性发作相似是影响远期预后的独立影响因子。结论难治性颞叶癫痫术后急性发作对患者远期预后存在影响,已明确的影响因子包括:复发次数、术前抗癫痫药≥3种,术后脑电图及术后急性发作与术前习惯性发作相似。

Objective To study the impact of acute postoperative seizures（ APOS） on the long-term prognosis in patients with medically intractable temporal lobe epilepsy. Methods The clinical data of 52 patients with medically intractable temporal lobe epilepsy who were admitted to our hospital from June 2009 to June 2010 were retrospectively analyzed. All patients received surgery and regular postoperative follow-up in the clinic or by telephone. According to the APOS situation within one week after surgery,these patients were divided into experimental group（ relapse） and control group（ non-relapse）. The follow-up data and long-term prognosis were compared between the two groups. Results The proportion of patients who were satisfied with seizure control was significantly lower in the experimental group than in the control group（ 35. 0% vs 68. 8%,χ2= 5. 683,P = 0. 017）. According to the multivariate logistic regression analysis,relapse frequency,the dosage of anti-epileptic drug（ AED） prior to surgery,postoperative electroencephalogram（ EEG）,and APOS that was similar to preoperative habitual seizures were independent influencing factors for the long-term prognosis.Conclusions APOS has an impact on the long-term prognosis in patients with refractory temporal lobe epilepsy. This study reveals several prognostic factors including relapse frequency,taking three or more types of AEDs prior to surgery,postoperative EEG,and APOS that is similar to preoperative habitual seizures.