儿童难治性癫痫的外科治疗

目的 分析儿童难治性癫痫的病因、外科手术的适应证和预后.方法 回顾性分析采用外科手术治疗342例儿童癫痫的经验.结果 皮质发育障碍是本组儿童难治性癫痫的最重要病因,占18.4%.药物难治性癫痫综合征占13.5%.术后疗效Engel Ⅰ级158例,Ⅱ级76例,Ⅲ级61例,Ⅳ级47例.平均智商(1Q)从术前的69.2分提高到79.8分.术前显示智力低下者术后亦有明显改善.结论 早期外科干预能有效地控制癫痫发作、改善智力损害,智力低下不应是外科治疗的禁忌证.同时,正确认识儿童难治性癫痫的病凶和病理埘儿童癫痫的外科治疗具有重要作用.

Surgery of pediatric intractable epilepsy

Objective To investigate the etiology, surgical indications and outcomes of pediatric intractable epilepsy. Method Surgery for 342 pediatric patients with intractable epilepsy between 1989-2007 were reviewed. The etiology was investigated according to the clinical data. 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 muhilobar resection with MST and/or corpus callosotomy were chosen to deal with hemispheric multiple epileptic foci. Results Malformation of cortical dysplasia was the most important pathology of pediatric intractable epilepsy. Intractable epilepsy syndromes were accounted for 13.5% of all pediatric intractable epilepsy. At follow-up on average 7.5 years after surgery,158 patients(45. 9%) had an Engel Class Ⅰ outcome after surgery and an additional 76 patients (22. 2%) had rare seizure (Engel Class Ⅱ), and 61 patients had a decrease in seizure frequency (Engel Class Ⅲ). Mean IQ improved from 69. 2 to 79. 8. Temporary complications were observed and there was no death. Conclusions Early surgical intervention in intractable pediatric epilepsy provides the good opportunity to control the seizure, prevent irreversible worse of intelligence. Imbecile IQ should not be a contra-indication of pediatric surgery. Understanding the etiology and pathology of pediatric intractable epilepsy will facilitate the surgery of pediatric epilepsy.