Abstract：
OBJECTIVE: Surgery is a treatment option for medically intractable epileptic spasms (ESs). However, outcomes of ES after surgery are not well understood, especially when surgeries aimed at seizure palliation are included. The purpose of the present study was to 1) investigate the proportion of favorable postoperative ES outcomes, 2) explore the preoperative factors related to favorable postoperative ES outcomes, and 3) examine the timing of ES recurrence after disconnection surgeries, including both curative and palliative indications.
METHODS: This retrospective study included patients who underwent disconnection surgery for medically intractable ES at the authors\' institution between May 2015 and April 2021. Patients with suggested focal-onset ES based on preoperative evaluations initially underwent lobar disconnection. Patients with suggested generalized or unknown-onset ES underwent corpus callosotomy (CC). If evaluations after initial CC showed focalized or lateralized change, they were considered secondarily revealed focal-onset ES, and lobar disconnection was performed. ES outcomes were evaluated using the International League Against Epilepsy classification. ES outcomes were divided into classes 1-4 as favorable outcomes and classes 5 and 6 as unfavorable outcomes. The relationship between the favorable postoperative ES outcomes and the following preoperative factors was analyzed: sex, age at onset (< or > 1 year), duration between seizure onset and initial surgery (< or > 2 years), type of seizure at onset (ES or others), presence of other types of seizures, substrate, hypsarrhythmia, and MRI abnormalities. The period between the last surgery and ES recurrence was also analyzed.
RESULTS: A total of 41 patients were included, of whom 75.6% achieved favorable ES outcomes. A longer seizure duration between seizure onset and initial surgery, presence of hypsarrhythmia, and positive MRI findings led to poorer postoperative ES outcomes (p = 0.0028, p = 0.0041, and p = 0.0241, respectively). A total of 60.9% of patients had ES recurrence during the follow-up period, and their ES recurred within 13 months after the last surgery.
CONCLUSIONS: Disconnection surgery is an effective treatment option for medically intractable ES, even when the preoperative evaluation suggests a generalized or unknown onset.
METHODS: This retrospective study included patients who underwent disconnection surgery for medically intractable ES at the authors\' institution between May 2015 and April 2021. Patients with suggested focal-onset ES based on preoperative evaluations initially underwent lobar disconnection. Patients with suggested generalized or unknown-onset ES underwent corpus callosotomy (CC). If evaluations after initial CC showed focalized or lateralized change, they were considered secondarily revealed focal-onset ES, and lobar disconnection was performed. ES outcomes were evaluated using the International League Against Epilepsy classification. ES outcomes were divided into classes 1-4 as favorable outcomes and classes 5 and 6 as unfavorable outcomes. The relationship between the favorable postoperative ES outcomes and the following preoperative factors was analyzed: sex, age at onset (< or > 1 year), duration between seizure onset and initial surgery (< or > 2 years), type of seizure at onset (ES or others), presence of other types of seizures, substrate, hypsarrhythmia, and MRI abnormalities. The period between the last surgery and ES recurrence was also analyzed.
RESULTS: A total of 41 patients were included, of whom 75.6% achieved favorable ES outcomes. A longer seizure duration between seizure onset and initial surgery, presence of hypsarrhythmia, and positive MRI findings led to poorer postoperative ES outcomes (p = 0.0028, p = 0.0041, and p = 0.0241, respectively). A total of 60.9% of patients had ES recurrence during the follow-up period, and their ES recurred within 13 months after the last surgery.
CONCLUSIONS: Disconnection surgery is an effective treatment option for medically intractable ES, even when the preoperative evaluation suggests a generalized or unknown onset.
摘要：
目的：手术是治疗药物难治性癫痫性痉挛（ESs）的一种选择。然而,手术后ES的结果还没有得到很好的理解，特别是当手术旨在减轻癫痫发作时。本研究的目的是1）调查良好的术后ES结局的比例，2）探讨与术后良好ES结局相关的术前因素，和3)检查断线手术后ES复发的时间，包括治愈和姑息适应症。
方法：这项回顾性研究纳入了作者机构于2015年5月至2021年4月期间接受药物难治性ES断流手术的患者。根据术前评估，建议发生局灶性ES的患者最初进行了肺叶断开。建议患有全身性或未知发作的ES的患者接受了骨体切开术（CC）。如果初始CC后的评估显示出集中或横向变化，他们被认为是次要发现的局灶性发作性ES，并进行了脑叶断开。使用国际抗癫痫联盟分类评估ES结果。ES结果分为1-4类作为有利结果，5和6类作为不利结果。分析术后良好的ES结局与以下术前因素之间的关系：性别，发病年龄（<或>1岁），癫痫发作和初次手术之间的持续时间（<或>2年），发作时的癫痫发作类型（ES或其他），存在其他类型的癫痫发作，基材,心律失常,和MRI异常。还分析了最后一次手术与ES复发之间的时间。
结果：共纳入41例患者，其中75.6%取得了良好的ES结果。癫痫发作和初次手术之间的癫痫发作持续时间较长，心律失常的存在，和阳性MRI结果导致术后ES结局较差(分别为p=0.0028,p=0.0041和p=0.0241).随访期间共有60.9%的患者出现ES复发,他们的ES在最后一次手术后的13个月内复发。
结论：分离手术是治疗药物难治性ES的有效选择，即使术前评估提示全身或未知的发病。
方法：这项回顾性研究纳入了作者机构于2015年5月至2021年4月期间接受药物难治性ES断流手术的患者。根据术前评估，建议发生局灶性ES的患者最初进行了肺叶断开。建议患有全身性或未知发作的ES的患者接受了骨体切开术（CC）。如果初始CC后的评估显示出集中或横向变化，他们被认为是次要发现的局灶性发作性ES，并进行了脑叶断开。使用国际抗癫痫联盟分类评估ES结果。ES结果分为1-4类作为有利结果，5和6类作为不利结果。分析术后良好的ES结局与以下术前因素之间的关系：性别，发病年龄（<或>1岁），癫痫发作和初次手术之间的持续时间（<或>2年），发作时的癫痫发作类型（ES或其他），存在其他类型的癫痫发作，基材,心律失常,和MRI异常。还分析了最后一次手术与ES复发之间的时间。
结果：共纳入41例患者，其中75.6%取得了良好的ES结果。癫痫发作和初次手术之间的癫痫发作持续时间较长，心律失常的存在，和阳性MRI结果导致术后ES结局较差(分别为p=0.0028,p=0.0041和p=0.0241).随访期间共有60.9%的患者出现ES复发,他们的ES在最后一次手术后的13个月内复发。
结论：分离手术是治疗药物难治性ES的有效选择，即使术前评估提示全身或未知的发病。
