胶质瘤相关性癫痫患者术后认知功能恢复及癫痫复发影响因素分析

Postoperative cognitive function recovery and risk factors for recurrent epilepsy in glioma-related epilepsy patients

目的分析胶质瘤相关性癫痫患者术后临床疗效、认知功能恢复情况及癫痫复发的影响因素。方法收集2015年4月至2017年1月于本院癫痫中心治疗的79例胶质瘤相关性癫痫患者的资料。所有患者均接受胶质瘤病灶及周围致痫灶切除手术,随访1年,记录患者癫痫复发情况,并判断患者认知功能恢复情况。结果 Engle分级评分在不同时间点存在显著差异(球形度检验F<94.68,P_均<0.05)。肿瘤分布于2个及多个脑叶、术后合并水肿及胶质瘤复发均为胶质瘤相关性癫痫患者术后癫痫再次发作的独立危险因素(P_均<0.05)。术后4个月患者长期记忆和总记忆商评分较术前均显著增加(P_均<0.05),短期记忆、瞬时记忆及韦氏智力量表评分较术前均无显著差异(P_均>0.05)。术后8个月和12个月,患者韦氏记忆和智力量表评分与术后4个月比较均无显著差异(P_均>0.05)。结论通过手术切除胶质瘤病灶及周围致痫灶能够加强患者术后癫痫控制情况,改善患者认知功能,但由于胶质瘤病灶部位的差异,不同患者术后癫痫复发风险不同。同时,应密切监测术后病灶周围是否出现水肿,并采取相应措施防止癫痫复发。

ObjectiveTo analyze the clinical effects, cognitive function recovery and inffuencing factors of epilepsy recurrence in patients with glioma-related epilepsy after operation. MethodThe data of 79 patients with glioma-related epilepsy treated in our hospital from April 2015 to January 2017 were collected. All patients underwent resection of gliomas and epileptogenic foci around them, and they were followed up for 1 year to record the recurrence of epilepsy and judge the recovery of cognitive function. ResultThere were signiffcant differences in Engle grading scores at different time points （sphericity test F〈94.68, Pall〈0.05）, suggested that epileptic symptoms gradually improved after operation. Glioma＇s distributing in 2 or multiple lobes, postoperative edema and glioma recurrence were the independent risk factors for recurrent epilepsy in patients with glioma-related epilepsy （Pall〈 0.05）. Long-term memory score and total memory quotient of patients 4 months after operation were signiffcantly higher than those before operation （Pall〈 0.05）. There were no signiffcant differences in short-term memory, instantaneous memory and Wechsler intelligence scale scores of patients between 4 months after operation and before operation （Pall〉0.05）. There were no signiffcant differences in Wechsler memory scale scores and Wechsler intelligence scale scores between 8 months and 12 months after operation compared with 4 months after operation （Pall〉 0.05）. ConclusionBy surgical removal of the glioma epileptogenic zone around the lesions can strengthen postoperative condition and improve cognitive situation of patients, but the risk of epilepsy recurrence after operation may be different for the differences of tumor location. Besides, for postoperative patients with lesions, appearance of edema around should be closely monitored, and necessary corresponding measures should be taken to prevent the recurrence of epilepsy attack.