立体脑电图引导的射频热凝术治疗儿童药物难治性癫痫的疗效(附71例报告)

目的探讨立体脑电图(SEEG)引导的射频热凝术(RF-TC)治疗儿童药物难治性癫痫的疗效和安全性。方法回顾性分析首都医科大学附属北京儿童医院癫痫中心2017年1月至2018年12月收治的71例药物难治性癫痫患儿的临床资料。发作类型为局灶性发作伴或不伴泛化62例,局灶性发作合并癫痫性痉挛6例,局灶性发作合并肌阵挛发作2例,单纯癫痫性痉挛1例。影像学表现为皮质发育畸形27例,海马硬化9例,发育性或低级别肿瘤8例,脑软化灶5例,合并2种类型病变5例,头颅MRI阴性17例。所有患儿均接受SEEG引导的RF-TC治疗。通过门诊复诊及电话随访评估患儿的癫痫发作情况,并采用单因素分析法探讨手术疗效的影响因素。结果71例患儿植入颅内电极5~14根/例。8例患儿行RF-TC后出现一过性神经功能损伤。69例随访(1.2±0.5)年(0.5~2.5年),2例失随访。末次随访时,45例(65.2%)无发作,24例仍有癫痫发作,其中18例(26.1%)发作减少>50%;术后随访时间>1年的42例患儿中,25例(59.5%)无发作。2例脑室旁结节状灰质异位患儿发作均控制1年以上,局灶皮质发育不良患儿的术后6个月的无发作率为85.7%(18/21)。单因素分析结果显示,手术疗效与电极植入目的(方案)有关(P=0.007),而与手术年龄、病程、癫痫发作类型、MRI阴性无关(均P>0.05)。结论对于儿童药物难治性癫痫,SEEG引导的RF-TC是一种安全、有效的治疗手段,其适用于体积小或深在的病灶,亦可探索MRI阴性的癫痫网络,为多发病灶、累及功能区者提供了手术机会,并能辅助切除性手术制定计划、评估疗效。

Efficacy of stereoelectroencephalography-guided radiofrequency thermocoagulation in the treatment of drug-resistant epilepsy in children:A report of 71 cases

Objective To investigate the efficacy and safety of stereoelectroencephalography(SEEG)-guided radiofrequency thermocoagulation(RF-TC)in the treatment of drug-resistant epilepsy in children.Methods Clinical data of 71 children with drug-resistant epilepsy admitted to Epilepsy Center,Beijing Children′s Hospital,Capital Medical University from January 2017 to December 2018 was retrospectively analyzed in this study.The patients′seizure types included focal seizure with or without generalization in 62 cases,focal seizure combined with epileptic spasm in 6 cases,focal seizure combined with myoclonic seizure in 2 cases,and epileptic spasm in 1 case.The MRI manifestations included malformation of cortical development in 27 cases,hippocampal sclerosis in 9 cases,developmental or low-grade tumors in 8 cases,encephalomalacia in 5 cases,dual lesions in 5 cases,and MRI negative in 17 cases.All 71 cases underwent SEEG-guided RF-TC and were followed up by outpatient visit and telephone in order to evaluate the patients′outcomes.The influencing factors of surgical outcomes were explored by using univariate logistic regression.Results Among the 71 patients,5-14 intracranial electrodes were implanted per case.Transient neurological impairment occurred in 8 cases after operation.There were 69 patients who were followed up for 1.2±0.5 years(0.5-2.5 years)and 2 cases lost to follow-up.Seizure free was achieved in 45 cases(65.2%)at the last follow-up and 18 cases(26.1%)reported a reduction of more than 50%in seizure frequency.Among the 42 cases followed up for>1 year post operation,25 cases(59.5%)were seizure free.Two cases with periventricular nodular heterotopia were seizure free over 1 year post operation.The cases with focal cortical dysplasia had a seizure-free rate of 85.7%(18/21).Univariate logistic regression analysis showed that the therapeutic effect was related to the purpose(design)of electrode implantation(P=0.007),while it was not related to the age of operation,duration of illness,seizure type or negative findings on MRI(all P>0.05).Conclusions SEEG-guided RF-TC is a safe and effective therapeutic method for drug-resistant epilepsy in children.It is favorable for small or deep lesions and could help explore the epileptic network of patients with negative MRI findings.SEEG-guided RF-TC provides a surgical opportunity for patients with multiple lesions or involving the eloquent cortex,which may be also helpful for making plans and predicting prognosis of resection surgery.