CAJ | 학술논문

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.
목적 탐토인동난치성섭협전간술전평고화수술방법 급영향전간예후적인소.방법 회고성분석2007년7월지2009년2월수술치료적21례인동난치성전간환자중득도수방적19례림상자료,주요위복잡부분성발작.다수환자유복부불괄등발작선조화잡취등발작시반수자동동작.MRI소묘15례이상.6례행PET소묘균이상.두피뇌전도시국조간성방전7례,다조간성방전12례.시행일측섭전협+해마、행인핵절제술15례,일측섭전협、해마、행인핵+부분액협피층절제술4례.결과 수방12-30개월,전간발작결과 ,Engel Ⅰ급13례;Ⅱ급3례;Ⅲ급1례;Ⅳ급2례.수방기간대4례진행신경심이학평고,2례명현호우술전.무영구성신경결손병발증.술후절제표본병리진단결과 위섭협피층발육불량화섭협내측경화등.결론 섭협절제치료인동난치성전간다수예후량호.해수술안전、병발증소.발작표현、EEG이급신경영상학검사대치간조정위상호부합시,예시예후량호.조기수술가능대환인적신경심이학개선유방조.
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.