儿童难治性癫痫手术前后对认知功能的影响

目的探讨难治性癫痫患儿外科手术治疗前后认知功能的变化。方法 27例儿童难治性癫痫患儿通过结构功能影像学、头皮长程视频脑电图(VEEG),需要时行侵入性脑电图(iEEG)等全面评估后个体化选择癫痫外科手术,于术前7天、术后3个月、6个月及12个月分别采用韦氏儿童智力量表第四版中文版(WISC-Ⅳ)测试患儿认知功能,评价手术前后认知功能,术后采用Engel分级评价手术治疗效果。结果 27例难治性癫痫儿童,术后随访12～36个月(平均随访22个月),17例患儿术后完全无癫痫发作,5例患儿术后发作极少,1年中仅1次,发作频率减少超过90%有3例,2例癫痫发作控制改善不明显,发作频率及症状未见明显改善。27例患儿配合完成了韦氏儿童智力量表第四版中文版(WISC-Ⅳ)测验,癫痫外科手术治疗后12个月患儿智商相比术前增加2.00～12.00(6.70±2.45)分(P0.001),认知功能改善有统计学意义,且开颅手术与迷走神经刺激术对患者认知功能影响的差异之间无统计学意义(P0.05)。结论癫痫外科手术对于难治性癫痫儿童安全且有效,可控制或减少术后发作频率,难治性癫痫儿童术后认知功能有不同程度提高。     

小儿难治性癫痫的手术治疗及病理结果分析

目的 探讨小儿药物难治性癫痫的外科治疗时机及病理结果与疗效的关系.方法 对71例小儿难治性癫痫进行手术治疗,术后至少随访1年,根据Engel预后分级评估手术效果.结果 术后随访的难治性癫痫患儿中,无癫痫发作(Engel Ⅰ级)的45例(63％),其中全切除32例,次全切除13例,仍有癫痫发作(EngelⅡ～Ⅳ级)的26例(37％),效果与致痫灶切除程度密切相关(P＜0.05).病理结果:局灶性脑皮质发育不良31例,低级别肿瘤18例,瘢痕脑回13例,小脑回畸形6例,结节性硬化3例,其中双重病理9例.无手术死亡和永久性并发症.结论 早期外科手术对小儿难治性癫痫是一种安全有效的治疗方式,其病理类型与手术结果存在一定相关性.     

迷走神经刺激术治疗难治性癫痫(附25例报告)

目的研究迷走神经刺激术治疗难治性癫痫的适应证选择、手术方法、术后程控及疗效。方法 2009年11月~2016年7月清华大学玉泉医院癫痫中心对25例难治性癫痫患者行迷走神经刺激术,术后给予程控管理控制癫痫发作;并通过随访回顾性分析术后疗效。结果术后随访患者4个月~7年,其中癫痫发作频率减少达McHughⅠ级6例、Ⅱ级12例、Ⅲ级4例、Ⅳ级1例、Ⅴ级2例。手术前后癫痫发作频率对比,差异有统计学意义(P0.05)。结论迷走神经刺激术作为一种安全有效的辅助治疗难治性癫痫的方法,其治疗效果可以随着参数的调整和时间延长而增强,并可以一定程度改善患者的认知行为和生活质量。     

胼胝体切开治疗药物难治性癫痫105例分析

目的 探讨胼胝体切开术治疗药物难治性癫痫的适应证、手术方法、有效性及安全性.方法 1999年1月至2010年8月单纯采用胼胝体切开术治疗105例药物难治性癫痫患者,发作类型以容易致残的全身性强直一阵挛发作(48例)、全身性强直发作(32例)或失张力发作(25例)为主.其中58例行胼胝体前2/3切开,47例行前3/4切开.结果 术后随访13～150个月,所有患者术后继续正规服用抗癫痫药物,13例(12.4%)患者术后发作消失,59例(56.2%)发作频率减少大于75%,22例(21.0%)发作频率减少50%～75%,9例(8.6%)无明显改善,2例(1.9%)加重.围手术期没有死亡病例,手术并发症较轻,且多为一过性.结论 对于无法行致痫灶切除术的药物难治性癫痫患者,胼胝体切开术能有效减少癫痫全身性发作的频率和严重程度.     

脑电定位与手术治疗难治性癫痫疗效观察

目的 探讨难治性癫痫的术前、术中脑电图定位方法及手术疗效.方法 对621例难治性癫痫患者采用普通脑电图监测(REEG)、长程脑电图监测(AEEG)、视频脑电图监测(VEEG),结合患者病史特点及影像学结果进行综合定位;术中在皮层脑电图(ECoG)监测下依据脑电图定位及不同发作类型选择适合术式切除致痫灶,并观察术后疗效.结果 术后随访6月至4年,满意(术后无发作)340例,占55%;显著改善(发作减少＞75%)223例,占36%;良好(发作减少50%～75%)37例,占6%;效差(发作减少＜50%)21例,占3%;无加重病例;有效率达97%.结论 以脑电图监测为基本手段,采用综合定位的方法结合术中ECoG监测明确癫痫灶的部位和范围以指导手术,能有效防止并发症的发生,并取得良好的治疗效果.     

胼胝体切开联合皮层热灼术治疗难治性癫痫(附82例回顾分析)

目的 探讨胼胝体切开联合皮层热灼术治疗难治性癫痫的手术方式与治疗效果.方法 82例难治性癫痫行胼胝体切开术治疗,其中18例行单纯胼胝体切开、33例行胼胝体切开 致痫皮层低功率电凝热灼、31例行单侧致痫灶切除 胼胝体切开 致痫皮层低功率电凝热灼.术后随访6个月～2年.结果 11例(13.4%)癫痫发作完全消失;41例(50%)癫痫发作次数显著减少;16例(19.5%)癫痫发作程度减轻;8例(9.8%)无明显改善;6例(7.3%)发作略有加重;无死亡病例.手术后疗效以Wilsion标准评判,优良率为83%.结论 部分性发作的癫痫患者,最可靠的治疗方法是致痫灶的切除,但对于全面性发作的病人,其致痫区往往比较广泛而无法切除,胼胝体切开可以阻断两侧半球间痫样放电的传播,联合皮层热灼术可以减少发作频率、减轻发作程度和改变发作形式,提高治疗效果.     

软膜下横切联合手术治疗难治性癫痫

目的观察软膜下横切术联合其它治疗癫痫手术方法,对难治性癫痫的治疗效果.方法对15例难治性癫痫采用软膜下横切联合手术进行临床观察、分析,判断其治疗效果.结果15例难治性癫痫病人采用联合手术方法,术后除2例病人有不同程度功能障碍及较轻癫痫发作外,其余病人均得到满意治疗效果.随访13例,失随访2例.满意8例(61.54%),显著改善4例(30.77%),良好1例(7.69%),总有效率100%.结论软膜下横切联合手术是难治性癫痫有效的外科治疗方法.     

迷走神经刺激术联合多种手术方式治疗儿童难治性癫痫(附2例报道)

目的总结迷走神经刺激术(vagus nerve stimulation,VNS)联合多种手术方式治疗儿童难治性癫痫的临床经验。方法回顾性研究2例VNS联合多种手术方式治疗儿童难治性癫痫术后1年临床资料,分析术后疗效。结果 2例儿童难治性癫痫患儿行VNS联合多种手术方式后1年,无癫痫发作。结论 VNS联合多种手术方式可有效治疗儿童难治性癫痫,丰富了儿童难治性癫痫治疗策略。     

药物难治性半球病变性癫痫手术治疗效果及手术方式比较的回顾性研究

目的探讨药物难治性半球病变性癫痫手术疗效,并对功能性大脑半球切除术和大脑半球离断术两种手术方式作比较。方法回顾性分析2005年至2017年在我科手术治疗的25例药物难治性半球病变性癫痫患者,根据所行手术方式分为功能性大脑半球切除术组(FH)15例,大脑半球离断术组(H)10例,对手术时间、术中出血、围手术期并发症、术后癫痫控制、神经功能作回顾性研究。结果术后随访1~12年,平均随访5.28±2.91年。除去失访2例总的癫痫发作控制率为Engel Ia 19例(82.60%)、Engel Id 3例(13.04%)、Engel IIa 1例(4.36%)。在癫痫控制率上,FH组与H组比无差异(p0.05)。在手术时间上,FH组手术时间较H组长,在术中失血上,FH组高于H组,且上述差异均有统计学意义(p0.05)。结论大脑半球切除术是一种有效的难治性半球病变性癫痫治疗措施,术后不仅能有效控制癫痫发作,且部分患者神经功能还得到改善,而大脑半球离断术作为一种创伤更小、疗效相当的手术方式,值得推广。     

国产迷走神经刺激器治疗药物难治性癫痫的疗效分析(附11例报告)

目的探讨国产迷走神经刺激器治疗药物难治性癫痫的疗效分析。方法对11例药物难治性癫痫患者进行国产迷走神经刺激手术治疗,术后2~4周开机,分次调试参数,脉冲发生器输出电流从0.2mA逐渐增加,刺激时间为30s,间歇5min,频率20~25Hz,脉宽250~500us。结果本组共计11例,随访1年,1例(9%)病人术后发作完全停止;3例(27%)病人术后发作频率减少75%;3例(27%)发作频率减少50%以上;3例(27%)发作频率减少25~50%;1例(9%)无改善;63.6%的难治性癫痫患者发作减少50%以上。结论迷走神经刺激是治疗药物难治性癫痫安全、有效的方法,治疗效果与刺激时间及参数调节有关。     

胼胝体切开术治疗儿童药物难治性癫(癎)

目的 探讨胼胝体切开术治疗无法行局灶性切除的儿童药物难治性癫(癎)的安全性及有效性.方法 回顾性分析113例儿童药物难治性癫(癎)病人的临床资料,均行胼胝体切开术.结果 术后发作完全消失77例(68.1％),发作减少90％以上21例(18.6％),其中失张力性发作病人术后发作完全消失和发作减少90％以上者分别占94.1％和5.9％,而全身强直性发作病人为8.3％和75.0％.术后出现短暂的主动性语言减少3例,并在术后6-8d内恢复.随访113例,时间12个月～5年,病人精神发育状态均有不同程度的改善,无发作加重病例.结论 胼胝体切开术是治疗儿童药物难治性癫(癎)的一种安全有效的方法,特别是对失张力性发作和全身强直性发作效果更佳.     

Outcome and long term follow-up after corpus callosotomy in childhood onset intractable epilepsy

Introduction Epilepsy surgery is a standard of care in the treatment of medically intractable epilepsy. Twenty five percent of patients with intractable epilepsy in childhood can be candidates for epilepsy surgery. Corpus callosotomy is a surgical treatment option for patients with potentially injurious drop attacks and disabling generalized seizures. Postoperative improvement of cognition and speech are important gains after epilepsy surgery particularly during childhood. The aim of this study is to evaluate the outcome of corpus callosotomy for the treatment of childhood onset medically intractable epilepsy in a developing pediatric epilepsy surgery center.Method We report 16 patients who underwent two thirds anterior corpus callosotomy for treatment of refractory seizures in childhood.Results All patients had drop attacks or multiple types of seizures, yet some showed focal onset with secondary generalization on electroencephalogram (EEG). One patient was seizure free (class 1 outcome), five had class 2A outcome, five had class 2B outcome, and five had class 3 outcome. Overall 11/16 (69%) of our patients improved significantly after anterior callosotomy.Conclusion Corpus callosotomy remains to be a fairly good choice of surgical treatment for childhood onset medically intractable epilepsy in selected patients.     

The early identification of candidates for epilepsy surgery

The effectiveness of resective surgery for the treatment of carefully selected patients with medically intractable, localization-related epilepsy is clear. Seizure-free rates following temporal lobectomy are consistently 65% to 70% in adults and 68% to 78% in children. Extratemporal resections less commonly lead to a seizure-free outcome, although one recent childhood series reported a seizure-free rate of 62% following extratemporal epilepsy surgery. With both temporal and extratemporal resections, additional patients have a reduction in seizures following surgery but are not completely seizure free. The identification of favorable surgical candidates has been the subject of extensive research, and many investigators have examined predictors of outcome following epilepsy surgery. However, the early identification of the potential epilepsy surgery candidate and the optimal timing of surgery have only occasionally been addressed in the literature. This issue is methodologically challenging to study since studies require large numbers of patients with new-onset partial epilepsy who are followed over time. The purpose of this article is to review the current ability for early prediction of medical intractability in patients with surgically remediable epilepsy. Emphasis will be placed on the early prediction of intractable temporal lobe epilepsy in children and adolescents, since temporal lobectomy remains the prototype epilepsy surgery, and early surgery may improve psychosocial outcome in younger patients.     

颞顶枕离断术治疗儿童单侧多脑叶难治性癫痫

目的 探讨颞顶枕离断术治疗儿童单侧多脑叶药物难治性癫痫的效果。方法 回顾性分析2009年9月至2014年5月在我院接受颞顶枕离断术治疗的17例儿童癫痫患者的临床资料,其中16例行单侧颞顶枕离断术,1例行前颞叶切除术后再行顶枕离断术。所有患者术后随访13~66个月,平均33.7个月。结果 按Engel分级评定癫痫控制效果:Ⅰ级10例,Ⅱ级3例,Ⅲ级3例,Ⅳ级1例。术前总智商为（47.3±11.2）分,术后为（56.7±9.7）分,两者差异显著（P<0.05）。17例患儿术后均出现对侧偏盲;2例术后第5天出现严重脑水肿,其中1例再次开颅手术切除枕叶。>结论 对致痫灶广泛分布于一侧的颞顶枕叶癫痫的儿童患者,颞顶枕离断术是安全有效的治疗方法。     

Efficacy and tolerability of adjunctive therapy with zonisamide in childhood intractable epilepsy

Purpose: This study investigated the efficacy and safety of zonisamide (ZNS) adjunctive therapy in children with intractable epilepsy to existing antiepileptic drugs (AEDs). Methods: A clinical retrospective study was performed from 2003 to 2005 at two tertiary epilepsy centers. We reviewed the data from 163 children (107 boys and 56 girls) who experienced more than four seizures per month, whose seizures were intractable to an initial 2 or more AEDs, and could be followed up for at least 6 months after ZNS adjunctive therapy initiation. Efficacy was estimated by seizure reduction rate according to seizure types including infantile spasms, and adverse events were also measured. Results: Seventy-nine patients (48.5%) out of 163 patients experienced a reduction in seizure frequency of more than 50%, and 25 patients (15.3%) became seizure-free. The rate of seizure reduction greater than 50% in children with partial seizures was 40.5% (17/42) and in children with generalized seizures was 51.2% (62/121). Of 36 patients who manifested mainly myoclonic seizures, 20 patients (55.6%) showed a seizure reduction of more than 50% and 9 patients (25.0%) were seizure-free. Mean maintenance dosage of drug was 8.2 mg/kg/day (range 5.0-16.0 mg/kg/day). Adverse events were documented in 15 children (9.2%), including somnolence (8 patients), fatigue, and anorexia, but all were transient and successfully managed. One patient discontinued ZNS therapy due to acute pancreatitis. Conclusion: ZNS adjunctive therapy is an effective and safe treatment in various childhood intractable epilepsy.     

难治性癫痫的偶极子定位手术治疗

目的：探讨利用偶极子三维颅内癫痫病灶定位系统对难治性癫痫病患者致痫灶定位，进行外科手术治疗的效果。方法：对1999年8月至2001年6月在我院实施的259例难治性癫痫患者运用偶极子三维颅内癫痫病灶定位系统对难治癫痫患者致痫灶进行术前精确定位，指导采用相应多种方式手术治疗，并探讨其疗效及随访结果。结果：随访6-22月者180例，疗效满意112例，显著改善（发作减少75%以上）36例，良好（发作减少50%以上）22例，疗效差10例。总有效率为94%。显效率82%，未发现任何远期功能损害。结论：偶极子三维颅内癫痫病灶定位系统是目前用于明确癫痫病灶定位较为先进的方法，准确指导手术，可明显提高手术效果，并减少并发症的产生。     

显微外科治疗颞叶癫痫的疗效分析

目的评价外科治疗难治性颞叶癫痫的手术疗效。方法回顾性分析外科的治疗236例难治性颞叶癫痫患者的临床资料。结果随访2-15年,疗效按Enge]的标准评定,236例中,Ⅰ级159例（67．4％）,Ⅱ级34例（14．4％）,Ⅲ级25例（10．6％）,Ⅳ级18例（7．6％）,总有效率为92.4％,效果优良率为81．8％。无严重并发症及手术死亡病例。结论应用显微外科技术治疗难治性颞叶癫痫是一种安全、有效的方法;对致痫灶的精确定位和正确处理及减少并发症是提高疗效的关键。     

前额叶孤立术治疗顽固性癫痫

目的总结8例大脑前额叶孤立术治疗顽固性癫痫的临床经验,探讨采用完全额叶孤立术治疗顽固性癫痫的可行性。方法以大脑半球切开术及后象限切开术为基础术式,将彻底孤立致痫灶的概念引入这种病例的治疗中,对8例致痫灶切除术后无效的额叶癫痫患者施行了额叶孤立术,为保证前额叶彻底孤立,在额叶切开的同时离断前连合和胼胝体前部。术后随访16个月,16个月后对8例患者统一以Engel分级法评估手术疗效。结果 8例患者手术过程均顺利,2例术后发热,行腰大池引流术,均恢复良好。术后疗效评估Engel分级Ⅰ级(术后癫痫停止发作)5例,Ⅱ级(每年发作1~2例)2例,Ⅲ级(发作频率减少75%以上)1例。结论前额叶孤立术可能是治疗难治性额叶癫痫的比较有效的方法之一。     

Extratemporal resection for childhood epilepsy

There have been relatively few studies reporting the safety, efficacy, and outcome in children undergoing extratemporal resection for epilepsy. We reviewed the pediatric cases of extratemporal resection for intractable epilepsy performed by the Comprehensive Epilepsy Program at the University of Alberta Hospitals between 1988-1998. Thirty-five patients were studied, 14 male and 21 female. The age at operation ranged from 6 months to 16 years. The operations included frontal excisions (12), parietal (8), occipital (4), hemispherectomies or multilobar resections (10), and one removal of a hypothalamic hamartoma. The pathology at surgery included patients with focal cortical dysplasia (8), brain tumors (6), neurocutaneous syndrome (7), Rasmussen's encephalitis (2), porencephalic cysts (4), hypothalamic hamartoma (1), and nonspecific gliosis (6). Twenty-four of 35 patients (68.5%) had an Engel Class I outcome after surgery and an additional six patients (11%) had a significant decrease in seizure frequency (Engel Class III). Complications were observed in two patients (5%) and there were no deaths. Extratemporal resection is a safe and effective treatment for children with intractable epilepsy. Overall, 68% of patients were seizure-free after surgery, although outcome may be dependent on site and pathology. A wide range of developmental pathology was observed including focal cortical dysplasia, brain tumors, and lesions with neurocutaneous syndromes. Many families reported improvement in behavior and psychosocial function after surgery.     

Complex partial seizures of childhood onset. A five-year follow-up study

Few detailed studies have examined the long-term outcome of complex partial seizures (CPS) in children and adolescents. Previous studies have selected patients on clinical criteria only or have included those with benign focal epileptiform discharges of childhood, nonepileptiform sharp transients, and generalized epileptiform discharges. We have followed up 29 patients with clinically and electroencephalographically defined CPS of childhood onset for five years or more. Twelve patients are seizure free, eight of them after having epilepsy surgery. Of the remaining, eight patients have intractable seizures. Only one patient was able to discontinue anticonvulsant therapy after epilepsy surgery. No patient had spontaneous remission of seizures without anticonvulsant medications. School difficulties, behavior problems, and unemployment were seen in half the group. We believe CPS in this age group are difficult to control and need aggressive management. In selected patients, epilepsy surgery offers a good chance of seizure control and improvement of educational, social, and vocational potential.