1岁以下存在明确致痫病灶儿童癫痫的手术治疗

Surgical treatment of epilepsy in children with definite epileptogenic lesion under 1 year old

目的探讨1岁以下存在明确致痫病灶儿童癫痫的临床特点、手术方法、并发症及预后。方法回顾性纳入2017年3月至2019年7月北京大学第一医院儿童癫痫中心行根治性手术,存在明确致痫病灶且手术年龄小于1岁的患儿,共14例。收集手术年龄、病程、病因、体检、发作类型、发作频率、发作间期脑电图(EEG)特征、手术方式、口服抗癫痫药物、病理等临床相关资料并分析。应用Engel分级标准评估术后疗效。采用Griffiths神经发育量表和Peabody各项运动发育量表检查进行运动神经发育评估。结果14例患儿手术年龄为119~358 d,中位年龄281 d;病程119~352 d,中位数为266 d;起病年龄为0~135 d,中位数为7.5 d。术后随访时间为0.5~2.0年,平均随访1.5年。末次随访无一例发作。随访期间共1例有发作,经调药后至今无发作。所有患儿随访期间认知和运动功能有进步。所有患儿均无术后感染、脑积水等严重并发症。结论低龄且存在明确致痫病灶的儿童癫痫起病早,对发育影响大。通过多学科术前评估,手术安全且可终止癫痫进展及发作,使患儿获得良好的发育时机,并可减少抗癫痫药物的服用。

Objective To investigate the clinical characteristics,surgical methods,complications and prognosis of children younger than 1 year old who had definite epileptogenic lesions under 1 year old.Methods A total of 14 children with definite epileptogenic lesions and underwent radical surgery in Pediatric Epilepsy Center of Peking University First Hospital from March 2017 to July 2019 were selected.Their clinical data including operation age,course of disease,etiology,physical examinations,seizure types,seizure frequency,features of interictal electrocorticography(EEG),surgical methods,antiepileptic drugs,and pathology were collected and analyzed.Postoperative efficacy was eva-luated using Engel grading.The Griffiths neurodevelopmental scale and the Peabody motor developmental scale were used to assess motor neurodevelopment.Results The operation age of 14 children was 119 to 358 days(median:281 days),and the course of disease ranged from 119 to 352 days(median:266 days).The age of onset was from 0 to 135 days was(median:7.5 days),and the postoperative follow-up time was 0.5-2.0 years(median:1.5 years).None of the patients had seizure recurrence at the last follow-up.During the follow-up period,1 patient had recurrence,but deve-loped no seizures anymore after drug administration.Cognitive and motor functions improved during follow-up in all children.All the children had no serious complications such as postoperative infection and hydrocephalus.Conclusions Young children with definite epileptogenic lesions have an early onset of seizures,which has a great influence on development.Multidisciplinary preoperative evaluation shows that surgery is a safe way to terminate progression of seizures,thus helping children to well develop and reducing the use of antiepileptic drugs.