病灶性癫痫的手术治疗及影响其预后的因素分析

目的 探讨病灶性癫痫的手术方法，并分析影响手术预后的一些因素。方法 回顾性地分析自2001年4月～2003年4月之间在我研究所接受手术治疗的所有病灶性癫痫患者的临床资料。33例患者手术后随访时间皆在1年或1年以上。按照Engel疗效分级标准，将其分为效果满意组与不满意组，对术前临床特点、电生理情况、手术方法等因素进行分析比较。结果 手术后效果满意率为73％。下列因素与手术效果有相关性：癫痫患病时间、发作频率以及脑电图发作间期痫性放电是否局限在病灶的脑叶上。另一方面，比较发病时年龄、是否有既发全面强直阵挛性发作以及是否完全切除术中皮层脑电监测(ECoG)为阳性的皮层三个因素，两组间无显著差异。不满意组中，皮质发育不全的患者占多数。结论 对于病灶性癫痫，手术采用病灶与周围致痫灶同时切除的方法，可获得满意的效果。癫痫患病时间、发作频率以及脑电图发作间期痫性放电是否局限在病灶的脑叶上与手术的效果有一定的相关性。

Surgical treatment of lesional epilepsy and its prognostic factors

Objective The purpose of the study is to discuss the surgical treatment of epilepsy patients due to lesions and analysis the presurgical factors relevant to the surgical outcome.Methods We studied 33 patients with epilepsy due to lesions who underwent a combined lesion and epileptogenic zone (epilepsy surgery) resection in our institute between April 2001 and April 2003.The patients were divided into satisfactory and unsatisfactory group according to Engel's classification of postoperative outcome.Some factors related to the characteristics of the epilepsy,the lesion and neurophysiological features,were considered for possible association with the outcome.Statistical analyses were performed between the two groups.Results Favorable surgical outcome was obtained in 24 patients.Satisfactory rate in this study was 73%.Outcome was significantly associated with seizure frequency,years with seizure and restricted interictal epileptiform discharge(IED) within the lesional lobe.On the other hand,no significant differences were found regarding different ages of seizure onset,different seizure semiology like generalized tonic clonic seizure and whether complete resection of cortex with epileptiform discharges detected by ECoG was gained.Cortical dysplasia was found to be the main pathologies in the unsatisfactory group.Conclusion For a patient with epilepsy due to a lesion,favorable outcome can be obtained by epilepsy surgery.The frequency of the seizures,the years with the seizures and the extent of the IED on scalp are the most relevant prognostic factors to the surgery outcome.