儿童期起病的颞叶癫痫术后疗效的预测因素分析

Predictive factors for surgical outcomes of patients with childhood onset temporal lobe epilepsy

目的探讨儿童期起病(起病年龄≤14岁)的颞叶癫痫术后疗效的预测因素。方法回顾性分析2011年1月至2018年12月手术治疗的173例儿童期起病的颞叶癫痫的临床资料。术后随访12~101个月,平均(49.4±22.9)个月;末次随访采用Engel分级标准评估疗效,其中Ⅰ级为疗效良好,Ⅱ~Ⅳ级为疗效不佳。结果173例中,Engel分级Ⅰ级135例(78.0%),Ⅱ级8例(4.6%),Ⅲ级20例(11.6%),Ⅳ级10例(5.8%)。无严重手术相关并发症及手术死亡病例。多因素logistic回归分析显示,术前MRI显示脑部异常、热性惊厥史是儿童期起病的颞叶癫痫术后疗效良好的独立预测因素(P<0.05)。结论儿童期起病的颞叶癫痫手术疗效良好。如果MRI显示脑部异常和/或伴热性惊厥史,建议采取手术治疗,可取得良好的效果。

Objective To investigate the predictive factors for surgical outcomes of the patients with childhood-onset(age at onset≤14 years)temporal lobe epilepsy.Methods The clinical data of 173 patients with childhood-onset temporal lobe epilepsy who underwent surgical treatment from January 2011 to December 2018 were retrospectively analyzed.The mean follow-up period was(49.4±22.9)months(range,12~101 months).At the last follow-up,Engel class was used to evaluate the outcomes,with classⅠas good outcome,and classⅡ~Ⅳas poor outcome.Results Of 173 patients,135(78.0%)patients had good outcomes,38(22.0%)had poor outcomes.There were no serious complications and operative death.Multivariate logistic regression analysis showed that positive preoperative MRI and history of febrile seizures were independent predictors of good postoperative outcomes in patients with childhood onset temporal lobe epilepsy(P<0.05).Conclusions Surgery is effective for the patients with childhood onset temporal lobe epilepsy.Surgical treatment is recommended for the patients with childhood onset temporal lobe epilepsy associated with a positive MRI and/or a history of febrile seizures,which can achieve good outcomes.