摘要
目的探讨儿童局灶性皮质发育不良(FCD)导致的药物难治性颞叶癫痫手术治疗效果及其影响因素。方法回顾性分析2017年1月至2019年6月手术治疗的60例药物难治性颞叶癫痫患儿的临床资料。术后根据Engel分级评估癫痫控制效果,Engel分级Ⅰ级为癫痫控制良好。结果术后病理诊断为FCDⅢ型。术前MRI检测:36例存在海马硬化典型特征,24例阴性。MRI阴性患儿中,17例为FCDⅢa型。MRI阴性患者致痫灶完全切除率(70.83%)较MRI阳性患者(97.22%)明显降低(P=0.005)。术后2年,35例(58.33%)癫痫控制良好;术后5年,42例(70.0%)癫痫控制良好。多因素logistic回归分析显示,病程长、MRI阴性是术后癫痫控制不良的独立危险因素(P<0.05),而致痫灶完全切除也是术后癫痫控制良好的保护因素(P<0.05)。结论多数儿童FCDⅢ导致的药物难治性颞叶癫痫,手术治疗后癫痫控制良好。MRI阴性影响患儿致痫灶完全切除率,导致术后癫痫控制效果欠佳。
Objective To investigate the surgical outcomes and influencing factors for drug-resistant temporal lobe epilepsy(TLE)caused by focal cortical dysplasia(FCD)in children.Methods A retrospective analysis was conducted on the clinical data of 60 children with drug-resistant TLE who underwent surgical treatment between January 2017 and June 2019.At the last postoperative follow-up,seizure control outcomes were assessed using the Engel classification,with Engel ClassⅠindicating favorable seizure control.Results Postoperative pathological findings diagnosed all cases as FCD typeⅢ.Preoperative MRI:36 cases exhibited typical features of hippocampal sclerosis,while 24 cases were MRI-negative.Among the MRI-negative patients,17(70.83%)were identified as FCD typeⅢa.The complete resection rate of the epileptogenic zone was significantly lower in MRI-negative patients(70.83%)compared to MRIpositive patients(97.22%;P=0.005).At the 2-year postoperative follow-up,35 cases(58.33%)achieved favorable seizure control;at the 5-year postoperative follow-up,42 cases(70.0%)exhibited favorable seizure control.Multivariate logistic regression analysis revealed that longer disease duration and MRI-negative status were independent risk factors for poor postoperative seizure control(P<0.05),while complete resection of the epileptogenic zone was a protective factor for favorable postoperative seizure control(P<0.05).Conclusion The majority of children with FCD typeⅢdrug-resistant TLE achieved favorable seizure control following surgical treatment.MRI-negative status affects the complete resection rate of the epileptogenic zone in children,leading to suboptimal postoperative seizure control outcomes.
作者
熊鹏举
陈祺龙
贺琳
刘庆
XIONG Peng-ju;CHEN Qi-long;HE Lin;LIU Qing(Department of Neurosurgery,The Second Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine,Nanchang 330012,China)
出处
《中国临床神经外科杂志》
2025年第8期479-482,共4页
Chinese Journal of Clinical Neurosurgery
基金
江西省科技计划项目(2022ZDJH6245)。
关键词
药物难治性癫痫
颞叶癫痫
局灶性皮质发育不良
儿童
手术效果
Drug-resistant epilepsy
Temporal lobe epilepsy
Focal cortical dysplasia
Children
Surgery
Outcome
