额叶癫痫患者手术后疗效及其影响因素的分析研究

Analysis and study of the curative effect and predictive factors of frontal lobe epilepsy after surgery

目的探究额叶癫痫患者手术后长期发作结局和影响预后的预测因素,以指导评估治疗并给予临床参考。资料和方法回顾性分析2016年1月—2020年2月于兰州大学第二医院功能神经外科经多模态癫痫外科评估体系精准评估并行手术治疗的30例额叶癫痫患者的临床资料,其中男17例、女13例,癫痫发作起始年龄(16.30±10.65)岁,手术治疗时年龄(23.98±11.04)岁,癫痫发作病程(7.68±6.37)年。多模态癫痫外科评估体系包括Ⅰ期无创评估和Ⅱ期侵入性评估,收集的各研究变量用描述性统计分析,采用多因素Logistic回归分析评估各研究变量对癫痫手术预后的重要性,确定潜在的预后预测因素,以探究额叶癫痫患者手术后癫痫控制情况及可能影响癫痫预后的各变量对预后疗效的影响。结果纳入的30例额叶癫痫患者临床资料分析结果显示,手术预后良好(EngelⅠ级)率为70%,平均随访(29.9±14.1)个月,多因素Logistic回归分析结果显示,癫痫病程、癫痫发作频率、是否行立体定向脑电图(SEEG)监测、致痫病灶是否完全切除、是否出现术后急性期癫痫发作是影响预后的独立预测因素(P<0.05)。结论癫痫病程长、发作频率频繁、出现术后急性期癫痫发作与不良预后显著相关,而SEEG的应用、致痫病灶的完全切除可显著改善手术预后。

Objective To explore the long-term seizure outcome and prognostic factors of patients with frontal lobe epilepsy after surgery, so as to guide the evaluation of treatment and provide clinical reference. Materials and methods This study retrospectively analyzed the clinical data of patients with frontal lobe epilepsy undergoing surgical treatment by multimodal epilepsy surgical evaluation system in the functional neurosurgery of the Second Hospital of Lanzhou University from January 2016 to February 2020, there were 17 males and 13 females, the age of onset of epileptic seizures was(16.30±10.65) years, the age at the time of surgical treatment was(23.98±11.04) years, and the duration of seizures was(7.68±6.37) years. The multimodal epilepsy surgical evaluation system includes phase I non-invasive evaluation and phase II invasive evaluation. The collected research variables were analyzed by descriptive statistics and multivariate logistic regression analysis to evaluate the importance of each research variable to the prognosis of epilepsy surgery, and to determine the potential prognostic factors, so as to explore the epilepsy control situation of patients with frontal lobe epilepsy after surgery and the influence of each variable that may affect the prognosis of epilepsy on the prognosis. Results The analysis of the clinical data of 30 patients with frontal lobe epilepsy showed that the good prognosis rate after FLE surgery(Engel I) was 70%, and the average follow-up was(29.9±14.1) months. The results of multivariate logistic regression analysis showed that the duration of epilepsy, the frequency of seizures, the presence or absence of stereotactic EEG(SEEG) monitoring, whether the lesion was completely removed, and whether acute postoperative seizures occurred were independent predictors of prognosis(P<0.05). Conclusion This study found that the long duration of epilepsy, frequent seizures, and postoperative acute seizures are significantly related to poor prognosis. The application of SEEG and complete resection of epileptic lesions can significantly improve the prognosis of FLE surgery.