儿童难治性颞叶癫痫的手术治疗

目的 探讨儿童难治性颞叶癫痫术前评估和手术方法 及影响癫痫预后的因素.方法 回顾性分析2007年7月至2009年2月手术治疗的21例儿童难治性癫痫患者中得到随访的19例临床资料,主要为复杂部分性发作.多数患者有腹部不适等发作先兆和咂嘴等发作时伴随自动动作.MRI扫描15例异常.6例行PET扫描均异常.头皮脑电图示局灶痫性放电7例,多灶痫性放电12例.施行一侧颞前叶+海马、杏仁核切除术15例,一侧颞前叶、海马、杏仁核+部分额叶皮层切除术4例.结果 随访12-30个月,癫痫发作结果 ,Engel Ⅰ级13例;Ⅱ级3例;Ⅲ级1例;Ⅳ级2例.随访期间对4例进行神经心理学评估,2例明显好于术前.无永久性神经缺损并发症.术后切除标本病理诊断结果 为颞叶皮层发育不良和颞叶内侧硬化等.结论 颞叶切除治疗儿童难治性癫痫多数预后良好.该手术安全、并发症少.发作表现、EEG以及神经影像学检查对致痫灶定位相互符合时,预示预后良好.早期手术可能对患儿的神经心理学改善有帮助.

Surgical treatment for refractory temporal lobe epilepsy in children

Objective To study the preoperative evaluation, surgical treatment strategies, and factors associated with seizure outcome of refractory temporal lobe epilepsy (TLE) in children.Methods Of a series of 21 children with refractory TLE, who were treated surgically during the period from July 2007 to February 2009, nineteen were followed up and their clinical data were retrospectively reviewed. Most patients had complex partial seizure, seizure aura such as abdominal discomfort, and automatism such as smacking lips and swallowing. MRI scanning demonstrated abnormal signal at temporal lobe in 15 cases. Six patients had abnormal results in PET scaning. Scalp EEG monitoring demonstrated local epilepsy discharge in 7 cases, and multiple locals in 12. Fifteen patients underwent surgery for removal of one side pretemporal lobe and amygdalohippocampus, and 4 had still partial cortex of the frontal lobe resection. Results The follow- up period ranged from 12 to 30 months. The seizure outcome according to Engel outcome scale were Ⅰ grade in 13 cases, Ⅱ in 3, Ⅲ 1 and Ⅳ in 2.Neuropsychological outcome: Two patients improved significantly. Postoperative pathology results included the brain cortex dysplasia and mesial temporal lobe sclerosis. Conclusions Most of the children who had temporal lobe surgery for intractable TLE had good seizure contral. The procedure is safe, with a low complication rate. A concordant localization of epileptogenic zone from seizure manifestation, EEG and neuroimaging studies may predict a favorable seizure outcome. Early surgical intervention may improve the neuropsychological scale.