药物难治性癫痫术后皮层脑电图病理波残留情况及其相关危险因素分析

Analysis of Residual Post-Resection Electrocorticography Status and Related Risk Factors in Patients With Medically Intractable Epilepsytractable Epilepsy

目的 分析药物难治性癫痫术后皮层脑电图(electrocorticography, ECoG)病理波残留情况,并寻找影响病理波残留的相关危险因素。方法 回顾性分析2006年1月–2018年1月我科经开颅行切除性手术治疗的药物难治性癫痫患者共146例,根据首次切除术后ECoG病理波结果将其分为无残留组(n=54)和残留组(n=92)。对于92例残留组患者则附加姑息性手术,再次评估术后ECoG改善情况,又可分为两个亚组:改善组(n=50)和无改善组(n=42)。比较各组患者癫痫年平均控制率的差异,利用单因素和多因素logistic回归分析影响术后病理波残留的相关危险因素。结果 术后随访10年,无残留组年平均癫痫控制率为86.7%,残留组年平均癫痫控制率为57.1%,两组间差异有统计学意义(P<0.001);改善组年平均癫痫控制率为71.0%,无改善组年平均癫痫控制率为46.5%,两组间差异有统计学意义(P=0.003)。logistic回归分析显示:性别(女)、手术年龄(>18岁)、多脑叶受累、功能区受累和MRI阴性是术后ECoG病理波残留的相关危险因素(P<0.05);而在亚组的分析中,多脑叶受累和功能区受累是姑息性手术术后ECoG病理波残留无改善的危险因素(P<0.05)。结论 根据术后ECoG病理波残留情况可以发现,无残留的患者疗效最优,而有残留但经历姑息性手术后明显改善的患者疗效次优。女性、手术年龄(>18岁)、多脑叶受累、功能区受累和MRI阴性的患者更容易出现术后ECoG病理波残留;而在术后ECoG病理波残留的患者中,多脑叶受累和功能区受累者即使经历附加的姑息性手术,术后ECoG病理波残留情况仍然改善不佳。

Objective To analyze the residual post-resection electrocorticography(ECoG) status and the related risk factors in patients with medically intractable epilepsy(MIE). Methods A retrospective analysis was conducted to cover 146 MIE patients who underwent craniotomy for surgical resection in the department of Neurosurgery, Second Affiliated Hospital of Chengdu Medical College between January 2006 and January 2018. The patients were divided into a non-residual group(n=54) and a residual group(n=92) according to their ECoG results after the first resection surgery. Then, the 92 patients in the residual group underwent additional palliative surgery and they were further divided into an improvement subgroup(n=50) and a non-improvement subgroup(n=42), according to the reevaluation results of improvements in their postoperative ECoG. The differences in the mean annual seizure-free rate among the groups were compared. Univariate and multivariate logistic regression analysis was conducted to analyze the risk factors of residual post-resection ECoG. Results During the ten-year follow-up after the operation, the mean annual seizure-free rate was 86.7% in the non-residual group and 57.1% in the residual group, showing significant difference between the two groups(P<0.001). In the subgroups, the mean annual seizure-free rate was 71% in the improvement subgroup and 46.5% in the non-improved subgroup, showing significant difference between the two subgroups(P=0.003).Logistic regression showed that risk factors associated with residual post-resection ECoG included being female, patient age at the time of surgery being over 18, multi-lobe epilepsy, functional area involvement, and negative MRI findings(P<0.05). Analysis of the subgroups showed that multi-lobe epilepsy and functional area involvement were risk factors related to not showing improvements in post-resection ECoG(P<0.05). Conclusions Findings based on the status of residual post-resection ECoG have shown that patients without residual post-resection ECoG had the best treatment outcomes, and patients who had residual post-resection ECoG, but showed significant improvement after palliative surgery had the second best treatment outcomes. Patients who were female, who had their surgeries when they were older than 18, and who had multi-lobe epilepsy, functional area involvement, or negative MRI results were more likely to have residual post-resection ECoG. Among patients with residual post-resection ECoG, those with multi-lobe epilepsy and functional area involvement showed little improvement in residual post-resection ECoG even after undergoing additional palliative surgery.