药物难治性颞叶癫患儿手术效果及其影响因素:附76例分析

目的总结药物难治性颞叶癫(MITLE)患儿的手术效果,探讨影响其手术预后的因素。方法以2005年6月—2009年3月进行手术,并至少随访1年的76例MITLE患儿为研究对象,应用多因素Logistic回归分析判断影响MITLE患儿手术效果的独立预测因素。结果 MITLE患儿手术后,根据Engel分级法,46例(60.5%)达到Ⅰ级,22例(28.9%)Ⅱ～Ⅲ级。多因素Logistic回归分析提示,首发年龄(P=0.034,OR=4.734,95%CI:1.121～17.067)、发作类型(P=0.033,OR=3.610,95%CI:1.111～11.732)是影响MITLE患儿手术效果的独立预测因素;既往病因、病程、MRI检查结果、发作频率、手术侧别、发作间期放电范围、IQ、服用抗癫药物对手术效果无独立预测作用。结论手术治疗儿童MITLE有效。首发年龄小、继发全面性发作的MITLE患儿手术治疗效果较差。

Surgical outcomes and its prognostic factors of intractable temporal lobe epilepsy in children: an analysis of 76 cases

Objective To summarize the surgical outcomes of medically intractable temporal lobe epilepsy in children,and to investigate the prognostic factors of the surgery.Methods Seventy-six patients(44 males and 32 females),operated from June 2005 to May 2009 and followed-up for at least 1 years were chosen as objects.Multivariate logistic regression analysis was used to determine the prognostic factors of temporal lobe surgical outcomes.Results According to the Engel classification,46 patients(60.5%)were in Engel’s class I,and 22 patients(28.9%)were in Engel’s class Ⅱ-Ⅲ.Multivariate logistic regression analysis found that age at epilepsy onset(P = 0.034,odds ratio,OR = 4.734,95% confidence interval,95%CI:1.121-17.067),seizures type(P = 0.033,OR = 3.610,95%CI:1.111-11.732)were the independent prognostic factors of temporal lobe surgical outcome in children.Etiology,epilepsy duration,MRI findings,seizure frequency,IQ,interictal discharge range,surgery side,taking antiepileptic drugs were not independent prognostic factors for surgical outcomes.Conclusions Surgery for temporal lobe epilepsy in children is effective.Children of temporal lobe epilepsy with early age at epilepsy onset,secondary generalized seizures have bad surgery outcomes.