小儿难治性癫痫综合征的外科治疗

目的总结外科手术治疗27例小儿难治性癫痫综合征病人的经验。方法术前评估和术中脑电检查显示为局灶性改变者行致痫灶切除、脑叶切除或多软膜下横纤维切断(MST)。检查提示一侧半球为主多灶性改变者,术中行多脑叶切除联合MST或(和)胼胝体部分切开。结果本组随访1-8年,平均4.5年。27例病人中有14例获得Ⅰ级(Engel分级),8例获得Ⅱ级,3例为Ⅲ级。平均智商(IQ)从术前的61.4分提高到75.0分,癫痫病程和术前药物难治的时间越短,智商改善越明显。本组4例病人出现暂时性的并发症,无手术死亡。结论对小儿难治性癫痫综合征进行早期外科干预,可以有效地控制癫痫发作、改善智力损害和避免生活残疾。

Surgery of pediatric patients with intractable epilepsy syndromes

Objective The drug-resistance in some epilepsy syndromes that begin in the childhood are predictable and show the tolerance to epilepsy surgery, and surgery of 27 pediatric patients with intractable epileptic syndromes between 1997-2004 were reviewed. Methods Resection of epileptogenic foci or lobe, and/or multiple subpial transection( MST) was followed when a focal epileptic discharge was indicated according to preoperative evaluation and EcoG, but multilobar resection with MST or/and corpus callosotomy were chosen to deal with hemispheric multiple epileptic foci. Results At follow-up, on average 4.5 years after surgery, fourteen of 27 patients (51.9% ) had an Engel Class I outcome after surgery and an additional eight patients (29. 6% ) had rare seizure (Engel Class II ) , and three patients had a decrease in seizure frequency ( Engel Class III ). Mean IQ improved from 61. 4 to 75. 0, and more IQ improvement followed the patients with shorter seizure history and drug-resistance time. Temporary complications were observed in four patients and there were no death. Conclusion Early surgical intervention in intractable pediatric epilepsy syndromes provides the good opportunity to control the seizure, prevent irreversible impairment of intelligence and avoid a lifetime of disability.