儿童额叶癫痫的临床特征以及切除性手术预后研究——儿童癫痫中心的经验

Clinical features and outcomes of resective surgery in children with frontal lobe epilepsy:The experience of children’s epilepsy center

目的分析儿童额叶癫痫的临床特征、手术预后以及两者的相关性。方法回顾性分析2017年1月—2019年12月复旦大学附属儿科医院三级癫痫中心收治并进行额叶致痫灶切除手术的额叶癫痫患儿18例,收集临床、头颅影像学、脑电图、智力发育以及病理等资料,术后随访至少2年以上并记录癫痫发作情况,利用单因素方法分析手术预后和临床表型之间的相关性。结果18例患儿中男11例、女7例,平均手术年龄(6.8±2.73)岁,年龄范围21月龄~11岁,病程1个月~9年。17例表现为局灶性发作、1例表现为全面性癫痫性痉挛发作。发作间期额区放电11例、额区外多脑区放电7例,发作期额区起始9例、额区外起始9例。核磁共振成像阳性改变14例、阴性4例。病因分别为局部皮层发育不良14例、发育性肿瘤2例、结节性硬化和胶质增生各1例。致痫病灶直接切除11例、立体定向脑电图深部电极植入后致痫灶切除7例。根据Engel分级,术后2年Ⅰ级14例(77.8%)、Ⅱ级1例(5.6%)、Ⅲ级2例(11.0%)、Ⅳ级1例(5.6%)。术后预后在性别、起病年龄、病程、致痫灶侧别、核磁共振成像阳性发现、发作间期放电和发作期放电起始、病因、智力发育水平以及立体定向脑电图植入上无统计学差异,在致痫病灶或致痫灶未能完成切除上存在统计学差异。结论儿童额叶癫痫中局部皮层发育不良是最常见的病因,通过手术完整切除致痫灶可以获得良好的癫痫发作控制的结局。

Objective To investigate clinical features and surgical outcome in children with frontal lobe epilepsy by evaluating the correlation between the predictive factors and seizure freedom.Methods 18 children who underwent frontal lobe epileptogenic resection in the Epilepsy Center of the Children’s Hospital of Fudan University between January 2017 and December 2019 with a minimum follow up of 2 year were analyzed retrospectively.Each patient was evaluated with detailed data to predict postsurgical seizure freedom by analysis of variance.Results Of the 18 patients,there were 11 males and 7 females,the age at surgery ranged from 21 months to 11 years old(6.8±2.73)and the duration of seizures was from 1 month to 9 years.17 patients had focal seizures,while 1 had generalized epileptic spasm.In scalp EEG,interictal and initial ictal discharges were frontal in 11 and 9 cases,respectively.MRI was indicative of FCD in 10 cases,tumor in 2,tuberous sclerosis and gliosis lesion in 1 case each.4 patients were MRI negative.11 patients underwent epileptogenic lesion resections directly and 7 cases received depth electrodes implantation and underwent stereoelectroencephalography to localize epileptogenic zone.At follow-up of 2 years,14(77.8%)patients remained seizure-free(EngelⅠ),1(5.6%)had marked seizure reduction(EngelⅡ),2(11.0%)showed minor improvement(EngelⅢ),and only 1(5.6%)showed no response(EngelⅣ).About predictors of seizure recurrence,there were no significant differences in gender,age at surgery,age of seizure onset,duration of epilepsy,lateralization of epileptogenic zone,positive MRI findings,interictal and ictal discharge,etiology,intellectual development and stereo-electroencephalography implantation,while significantly higher rates of seizure freedom correlated with complete the resection of the epileptogenic zone.Conclusions Focal cortical dysplasia is the most common cause in childhood with frontal lobe epilepsy and complete resection of the epileptogenic zone can lead to good seizure control outcome.