并发癫痫的脑动静脉畸形患者血管内栓塞治疗后生活质量分析

Quality of life after endovascular embolization of cerebral arteriovenous malfamation patients who present with seizures

目的评估未破裂动静脉畸形(CAVM)并发癫痫发作的患者血管内栓塞治疗后癫痫发作、头痛症状缓解情况及生活质量状况。方法收集62例合并癫痫发作、未发生破裂出血的CAVM患者临床资料,应用癫痫患者生活质量量表(QOLIE-31)评估患者生活质量,分析血管内栓塞治疗对CAVM患者生活质量的影响。结果经过8~74个月(中位数为28.5个月)的随访,与血管内栓塞治疗前相比患者的生活质量在发作担忧、综合健康状况和生活质量评定、情绪/情感、精力/疲乏、认知功能和社会功能方面有改善(P<0.05或P<0.01),药物影响方面与术前比较(P>0.05)。Spetzler-Martin分级低级别动静脉畸形患者术后生活质量好于高级别组(P<0.05),且达到完全栓塞或次全栓塞的患者生活质量评分高于部分栓塞组(P<0.01)。术后癫痫发作控制满意的患者生活质量总评分高于癫痫发作控制不满意组(P<0.01)。术后慢性头痛患者症状均有不同程度改善,且生活质量总评分高于栓塞治疗前(P<0.05)。结论未破裂脑CAVM并发癫痫发作的患者血管内栓塞治疗后生活质量较术前有改善,患者可能通过癫痫发作、头痛症状的良好控制以及对出血风险下降的认知能力而获益。

Objective To evaluate the quality of life of unruptured cerebral arteriovenous malfamation(CAVM)patients who present with seizures and the variation of seizure and headache.Method We collected the clinical information of sixty-two unruptured CAVM patients who present with seizures and evaluated their quality of life with QOLIE-31.And we analyzed the influence of intravascular embolization treatment on the quality of life of patients with CAVM.Results The follow-up periods ranged from8to74months(mean,28.5months).The patient's quality of life has improved in items of seizure worry,overall quality of life,emotional well-being,energy/fatigue,cognitive,social function compared with the preoperative(P<0.05or P<0.01).We didn't find the significant differences in the item of drug effects(P>0.05).The quality of life of patients with low level in Spetzler-Martin classification is better than which of patients with high level(P<0.05).The quality of life of patients who received complete embolization or closely completeem bolization is btter than patients who received incomplete embolization(P<0.05).The quality of life of patients who received well seizure control is better than patients who received poor seizure control(P<0.01).The quality of life of patients with chronic headaches improved after endovascular embolization(P<0.05).Conclusion Endovascular embolization may improve the quality of life of unruptured CAVM patients who present with seizures.Patients may benefit by controlling the seizures、headaches and by understanding the reduced risk of hemorrhage.