Abstract：
OBJECTIVE: Epileptic Encephalopathy / Developmental Epileptic Encephalopathy with spike-and-wave activation during sleep (EE/DEE-SWAS) is a self-limiting childhood epilepsy syndrome but may cause permanent neurocognitive impairment. Surgical interventions have been controversial in the treatment of EE/DEE-SWAS. This systematic review aims to evaluate the efficacy of various surgical procedures on the outcomes of EE/DEE-SWAS.
METHODS: A systematic review was performed per the PRISMA guidelines. A total of 14 retrospective studies were identified, comprising 131 cases of EE/DEE-SWAS treated with epilepsy surgery. The review analyzed presurgical data, surgical interventions, as well as outcomes related to seizures, EEG, and neuropsychological assessments.
RESULTS: Epilepsy surgery was successfully performed in 131 cases with minor complications. The average age was 2.6 years at seizure onset and 5.0 years at diagnosis of SWAS. Excellent seizure control (Engel I and II) was achieved in 80.6 %, 78.6 %, 77.4 % and 27.2 % of patients receiving hemispherectomies, focal resections, multiple subpial transections (MSTs), and corpus callosotomies (CCTs), respectively. EEG SWAS resolution was seen in 79.7 % of hemispherectomy cases, 78.6 % in focal resections, 63.9 % in MSTs, and 8.3 % in CCTs. Neurocognitive and behavioral improvement was noted in 58.0 %, 71.4 %, 58.3 % and 16.7 % for patients receiving hemispherectomies, focal resections, MSTs, and CCTs, respectively. A correlation between improved seizure control and SWAS resolution was observed with improved neuropsychological outcomes.
CONCLUSIONS: Epilepsy surgery is a safe and effective treatment for carefully selected children with drug-resistant EE/DEE-SWAS. Patients who underwent epilepsy surgery had reduction of seizure burden, SWAS resolution and improvements in neurocognitive and behavioral function.
METHODS: A systematic review was performed per the PRISMA guidelines. A total of 14 retrospective studies were identified, comprising 131 cases of EE/DEE-SWAS treated with epilepsy surgery. The review analyzed presurgical data, surgical interventions, as well as outcomes related to seizures, EEG, and neuropsychological assessments.
RESULTS: Epilepsy surgery was successfully performed in 131 cases with minor complications. The average age was 2.6 years at seizure onset and 5.0 years at diagnosis of SWAS. Excellent seizure control (Engel I and II) was achieved in 80.6 %, 78.6 %, 77.4 % and 27.2 % of patients receiving hemispherectomies, focal resections, multiple subpial transections (MSTs), and corpus callosotomies (CCTs), respectively. EEG SWAS resolution was seen in 79.7 % of hemispherectomy cases, 78.6 % in focal resections, 63.9 % in MSTs, and 8.3 % in CCTs. Neurocognitive and behavioral improvement was noted in 58.0 %, 71.4 %, 58.3 % and 16.7 % for patients receiving hemispherectomies, focal resections, MSTs, and CCTs, respectively. A correlation between improved seizure control and SWAS resolution was observed with improved neuropsychological outcomes.
CONCLUSIONS: Epilepsy surgery is a safe and effective treatment for carefully selected children with drug-resistant EE/DEE-SWAS. Patients who underwent epilepsy surgery had reduction of seizure burden, SWAS resolution and improvements in neurocognitive and behavioral function.
摘要：
目的：癫痫性脑病/发育性癫痫性脑病（EE/DEE-SWAS）是一种自限性儿童癫痫综合征，但可能导致永久性神经认知障碍。手术干预在EE/DEE-SWAS的治疗中一直存在争议。本系统评价旨在评估各种外科手术对EE/DEE-SWAS预后的疗效。
方法：根据PRISMA指南进行系统评价。共确定了14项回顾性研究，其中EE/DEE-SWAS行癫痫手术治疗131例。审查分析了术前数据，手术干预，以及与癫痫发作相关的结果，脑电图,和神经心理学评估。
结果：癫痫手术131例成功，并发症少。癫痫发作时的平均年龄为2.6岁，诊断为SWAS时的平均年龄为5.0岁。80.6%实现了出色的癫痫发作控制(EngelI和II)，78.6%,77.4%和27.2%接受大脑半球切除术的患者，病灶切除,多个下横切术（MST），和call体切开术（CCT），分别。在79.7%的大脑半球切除术病例中观察到EEGSWAS分辨率,病灶切除78.6%，MST占63.9%，和8.3%的CCT。58.0%的人注意到神经认知和行为改善，71.4%,接受大脑半球切除术的患者占58.3%和16.7%，病灶切除,MSTs,和CCT，分别。观察到改善的癫痫发作控制与SWAS分辨率之间的相关性与改善的神经心理学结果。
结论：癫痫手术对于精心挑选的耐药EE/DEE-SWAS患儿是一种安全有效的治疗方法。接受癫痫手术的患者癫痫发作负担减轻，SWAS分辨率和神经认知和行为功能的改善。
方法：根据PRISMA指南进行系统评价。共确定了14项回顾性研究，其中EE/DEE-SWAS行癫痫手术治疗131例。审查分析了术前数据，手术干预，以及与癫痫发作相关的结果，脑电图,和神经心理学评估。
结果：癫痫手术131例成功，并发症少。癫痫发作时的平均年龄为2.6岁，诊断为SWAS时的平均年龄为5.0岁。80.6%实现了出色的癫痫发作控制(EngelI和II)，78.6%,77.4%和27.2%接受大脑半球切除术的患者，病灶切除,多个下横切术（MST），和call体切开术（CCT），分别。在79.7%的大脑半球切除术病例中观察到EEGSWAS分辨率,病灶切除78.6%，MST占63.9%，和8.3%的CCT。58.0%的人注意到神经认知和行为改善，71.4%,接受大脑半球切除术的患者占58.3%和16.7%，病灶切除,MSTs,和CCT，分别。观察到改善的癫痫发作控制与SWAS分辨率之间的相关性与改善的神经心理学结果。
结论：癫痫手术对于精心挑选的耐药EE/DEE-SWAS患儿是一种安全有效的治疗方法。接受癫痫手术的患者癫痫发作负担减轻，SWAS分辨率和神经认知和行为功能的改善。
