局灶性皮层发育不良相关难治性癫痫的手术预后影响因素分析

Analysis of prognostic factors in patients with intractable epilepsy induced by focal cortical dysplasia

目的探讨局灶性皮层发育不良(focal cortical dysplasia,FCD)相关难治性癫痫的手术治疗效果及预后影响因素。方法回顾性分析63例FCD相关难治性癫痫患者的临床资料。所有FCD均经术后病理证实。随访12~36个月,根据Engel分级评定患者预后,EngelⅠ级定义为预后良好,EngelⅡ~Ⅳ级定义为预后不佳。使用χ^(2)检验对磁共振(magnetic resonance,MR)评估结果、病程、手术切除方式及其他相关因素进行单因素分析;应用logistic回归分析进一步探讨手术预后的影响因素。结果本研究入组FCD患者63例,其中FCDⅠ型19例,FCDⅡ型17例,FCDⅢ型27例。术后36例(57.14%)预后良好,27例(42.86%)预后不佳。单因素分析显示病程、MR评估结果、视频脑电图(video-electroencephalography,VEEG)与MR定位是否一致及切除方式是手术预后的影响因素(P<0.05),而性别、年龄、服用抗癫痫药物种类、病灶位置、病理类型对预后无显著影响(P>0.05)。多因素logistic回归分析结果表明病程≥10年、VEEG与MR定位不一致是患者术后预后不佳的独立影响因素。结论FCD相关难治性癫痫患者的预后受多种因素影响,病程长的患者更易预后不佳。FCD相关难治性癫痫患者需要积极采取手术治疗,术前致痫灶的定位尤为重要。

Objective To investigate the factors influencing the prognosis of refractory epilepsy related to focal cortical dysplasia(FCD).Methods The clinical data of 63 patients with refractory epilepsy related to FCD were retrospectively analyzed.All FCDs were confirmed by postoperative pathology.The patients were followed up for 12 to 36 months after operation,and the prognosis was assessed according to Engel grading,with EngelⅠas good prognosis and EngelⅡ~Ⅳas poor prognosis.Theχ^(2 )test univariate analysis was performed to evaluate the roles of MR assessment results,courses of disease,surgical resection methods,and other related factors.Logistic regression analysis was used to further explore the factors affecting the prognosis of surgery.Results This study included 63 FCD patients,including 19 of FCD typeⅠ,17 of FCD typeⅡ,and 27 of FCD typeⅢ.36 cases(57.14%)were classified as EngelⅠ,which meant good prognosis,and 27 cases(42.86%)were poor prognosis.Univariate analysis showed that MR assessment results,the consistency of VEEG and MR localization,disease course and surgical methods were the influencing factors of surgical prognosis(P<0.05),while gender,age,antiepileptic drugs,lesion location,and pathological classification had no significant effect on prognosis(P>0.05).Multivariate logistic regression analysis showed that disease duration≥10 years and inconsistency between VEEG and MR localization were important predictors of poor postoperative results.Conclusion The prognosis of patients with FCD related refractory epilepsy is affected by some factors,and a longer course of the disease may be detrimental to the prognosis.The high preoperative precision location of epileptogenic foci is particularly important.