胶质瘤相关性癫痫患者术后痫性再发的临床特征及影响因素

Postoperative epileptic recurrence in patients with glioma-related epilepsy:Clinical characteristics and risk factors

目的既往关于胶质瘤相关性癫痫患者临床发作特征的研究较少,部分患者术后癫痫仍然存在,痫性再次发作严重影响了患者的恢复。文中旨在探讨胶质瘤相关性癫痫患者发作时持续时间,发作频率以及发作类型,以及术后痫性再次发作可能的相关因素。方法选取2010年5月至2015年5月于郑州大学第五附属医院神经外科治疗的89例胶质瘤相关性癫痫患者。所有患者均行胶质瘤与致痫灶切除术,记录患者术前术后痫性发作频率和持续时间,对痫性再次发作相关因素行Cox比例风险模型分析,探讨痫性再发的危险因素。结果 24例痫性再发患者术前持续时间、频率[7(3~10)min、6.5(4~9)次/月]较65例未再发患者[5(2~9)min、5(3~9)次/月]明显升高(P<0.05)。24例痫性再发患者术后持续时间、频率[1(0.5~2.0)min、1.5(1~3)次/月]较术前明显减少(P<0.05)。累积部位(多脑叶)[HR=4.782,95%CI:1.647~13.880],瘤周水肿带(>2 cm)[HR=3.960,95%CI:1.358~11.547],癫痫样脑电波[HR=3.359,95%CI:1.195~9.448],术前痫性发作频率(>6次/月)[HR=3.869,95%CI:1.393~10.744]、肿瘤复发[HR=8.549,95%CI:3.489~20.949]是痫性再发的危险因素。结论对伴有危险因素的患者应积极采取相应的综合治疗措施,有望减少术后痫性再发。尤其对于发作持续时间、频率均大于6的患者应格外关注。

Objective Few studies are reported on the clinical characteristics of glioma-related epilepsy （GRE）. Postopera- tive recurrence of epilepsy in some patients seriously affects their recovery. We aimed to explore the duration, frequency and type of the epileptic seizure as well as possible factors for postoperative recurrence of epilepsy. Methods We recorded the frequency and dura- tion of epileptic seizures, analyzed the recurrence-related factors using the Cox regression model, and investigated the risk factors of re-current epilepsy. Results The postoperative recurrence of epilepsy was found in 24 （26.97%） of the 89 cases, which, compared with the 65 non-recurrence cases, had a significantly longer seizure dura- tion （ 7 [ 3-10 ] vs 5 [ 2- 9 ] rain, P〈 0.05 ） and higher onset frequency （6.514-9] vs 5[3-9] times/mo, P〈0.05） preoperatively. After surgery, the 24 recurrence cases showed a remarkably reduced seizure duration （1[0.5-2.0] min, P〈0.05） and onset frequency （1.5[1-3] times/too, P〈0.05）. The main risk factors for epileptic recurrence included the level of the glioma-involved site （HR= 6.728, 95% CI：2.994-15.116）, peritumoral edema （〉2 cm） （HR=2.867, 95% CI： 1.210-6.795）, brain wave type （HR=2.501, 95% CI： 1.058 -5.914）, and preoperative frequency of epileptic seizure （〉6 times/mo） （HR=5.100, 95% CI： 2.437-10.677）. Conclusion Postoperative recurrence of epilepsy is associated with the clinical pathological parameters, and the changes of the frequency and dura- tion of epileptic seizures before and after surgery may provide some new theoretical reference for the treatment and prognosis of the disease.