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Abstract：
There is a paucity of data on longitudinal seizure outcome of children undergoing epilepsy surgery. All children (n = 132) who underwent resective epilepsy surgery from January 1998 to December 2015 were identified. Relevant clinical, neurophysiological, imaging, surgical and seizure outcome data were extracted. Multivariable logistic regression analysis and Kaplan-Meier survival with Cox proportional hazard modelling were performed. The mean age at surgery was 7.8 years (range 0.2-17.9). 71% were seizure-free at a mean follow up of 5.3 ± 2.7 years. Of those who were seizure-free, 65 patients were able to completely wean off anti- seizure medications successfully. Using survival analysis, the probability of Engel Class I outcome at one year after surgery was 81% (95% confidence interval [CI] 87%-75%). This dropped to 73% at two years (95% CI 81%-65%), 58% at five years (95% CI 67.8%-48%), and 47% at ten years. Proportional hazard modelling showed that the presence of moderate to severe developmental disability (HR 6.5; p = 0.02) and lack of complete resection (HR 0.4; p = 0.02) maintain association as negative predictors of seizure-free outcome. Our study demonstrates favorable long-term seizure control following pediatric epilepsy surgery and highlights important predictors of seizure outcome guiding case selection and counseling of expectations prior to surgery.
摘要：
关于接受癫痫手术的儿童的纵向癫痫发作结果的数据很少。所有1998年1月至2015年12月接受切除性癫痫手术的儿童（n=132）均被确认。相关临床,神经生理学，成像,提取手术和癫痫发作结果数据.多变量logistic回归分析和Kaplan-Meier生存与Cox比例风险模型。手术时的平均年龄为7.8岁（范围为0.2-17.9）。平均随访5.3±2.7年，71％无癫痫发作。在那些没有癫痫发作的人中，65名患者成功地完全戒除了抗癫痫药物。使用生存分析，手术后1年出现EngelI类结局的概率为81%(95%置信区间[CI]87%-75%).这一数字在两年内降至73%(95%可信区间81%-65%)，五年时为58%（95%CI67.8%-48%），和47%的十年。比例危险模型显示，中度至重度发育障碍（HR6.5；p=0.02）和缺乏完全切除（HR0.4；p=0.02）的存在作为无癫痫发作结局的负预测因子。我们的研究表明，小儿癫痫手术后的长期癫痫发作控制良好，并强调了癫痫发作结局的重要预测因素，指导病例选择和手术前的期望咨询。
