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Abstract：
OBJECTIVE: To provide evidence for choosing surgical or nonsurgical treatment for epilepsy in patients with unilateral multilobar and hemispheric polymicrogyria (PMG).
METHODS: We searched published studies until September 2022 related to unilateral multilobar and hemispheric PMG and included patients who were followed up at the Pediatric Epilepsy Centre of Peking University First Hospital in the past 10 years. We summarized the clinical characteristics and compared the long-term outcomes after surgical or nonsurgical (anti-seizure medications, ASMs) treatment.
RESULTS: A total of 70 patients (49 surgical, 21 non-surgical) with unilateral multilobar and hemispheric PMG were included. The median age at epilepsy onset was 2.5 years (1.0-4.1). The most common seizure types were focal and atypical absence seizures. In the whole cohort, 87.3% had hemiparesis and 67.1% had electrical status epilepticus during slow sleep (ESES). There were significant differences in age at epilepsy onset, extent of lesion, and EEG interictal discharges between the two groups. At the last follow-up (median 14.1 years), the rates of seizure-freedom (81.6% vs. 57.1%, p = 0.032) and ASM discontinuation (44.4% vs. 6.3%, p = 0.006) were higher in the surgical group than in the nonsurgical group. Patients in the surgical group had a higher rate of seizure-freedom with complete resection/disconnection than with subtotal resection (87.5% vs. 55.6%, p = 0.078), but with no statistically significant difference. In the nonsurgical group, more extensive lesions were associated with worse seizure outcomes. Cognition improved postoperatively in 90% of surgical patients.
CONCLUSIONS: In patients with unilateral multilobar and hemispheric PMG, the age of seizure onset, the extent of the lesion and EEG features can help determine whether surgery should be performed early. Additionally, surgery could be more favorable for achieving seizure freedom and cognitive improvement sooner.
CONCLUSIONS: We aim to summarize clinical characteristics and compare the long-term outcomes after surgical and nonsurgical (ASM) treatment to provide a basis for treatment decisions for patients with unilateral multilobar and hemispheric polymicrogyria (PMG)-related epilepsy. We found that patients with unilateral hemispheric and multilobar PMG had significantly higher rates of seizure freedom and ASM discontinuation with surgical treatment than with nonsurgical treatment. In the surgical group, seizure outcomes were better in patients treated with complete resection/disconnection than in those treated with subtotal resection, but the difference was not statistically significant.
METHODS: We searched published studies until September 2022 related to unilateral multilobar and hemispheric PMG and included patients who were followed up at the Pediatric Epilepsy Centre of Peking University First Hospital in the past 10 years. We summarized the clinical characteristics and compared the long-term outcomes after surgical or nonsurgical (anti-seizure medications, ASMs) treatment.
RESULTS: A total of 70 patients (49 surgical, 21 non-surgical) with unilateral multilobar and hemispheric PMG were included. The median age at epilepsy onset was 2.5 years (1.0-4.1). The most common seizure types were focal and atypical absence seizures. In the whole cohort, 87.3% had hemiparesis and 67.1% had electrical status epilepticus during slow sleep (ESES). There were significant differences in age at epilepsy onset, extent of lesion, and EEG interictal discharges between the two groups. At the last follow-up (median 14.1 years), the rates of seizure-freedom (81.6% vs. 57.1%, p = 0.032) and ASM discontinuation (44.4% vs. 6.3%, p = 0.006) were higher in the surgical group than in the nonsurgical group. Patients in the surgical group had a higher rate of seizure-freedom with complete resection/disconnection than with subtotal resection (87.5% vs. 55.6%, p = 0.078), but with no statistically significant difference. In the nonsurgical group, more extensive lesions were associated with worse seizure outcomes. Cognition improved postoperatively in 90% of surgical patients.
CONCLUSIONS: In patients with unilateral multilobar and hemispheric PMG, the age of seizure onset, the extent of the lesion and EEG features can help determine whether surgery should be performed early. Additionally, surgery could be more favorable for achieving seizure freedom and cognitive improvement sooner.
CONCLUSIONS: We aim to summarize clinical characteristics and compare the long-term outcomes after surgical and nonsurgical (ASM) treatment to provide a basis for treatment decisions for patients with unilateral multilobar and hemispheric polymicrogyria (PMG)-related epilepsy. We found that patients with unilateral hemispheric and multilobar PMG had significantly higher rates of seizure freedom and ASM discontinuation with surgical treatment than with nonsurgical treatment. In the surgical group, seizure outcomes were better in patients treated with complete resection/disconnection than in those treated with subtotal resection, but the difference was not statistically significant.
摘要：
目的：为单侧多叶和半球多微回旋症（PMG）患者选择手术或非手术治疗提供依据。
方法：我们检索了2022年9月之前发表的与单侧多叶和半球PMG相关的研究，包括过去10年在北京大学第一医院小儿癫痫中心随访的患者。我们总结了临床特征，并比较了手术或非手术后的长期结局（抗癫痫药物，ASM)治疗。
结果：共有70例患者（49例手术，包括21个非手术）的单侧多叶和半球PMG。癫痫发作的中位年龄为2.5岁（1.0-4.1）。最常见的癫痫发作类型是局灶性和非典型失神发作。在整个队列中，在缓慢睡眠（ESES）期间，有87.3％的偏瘫和67.1％的癫痫持续状态。癫痫发作的年龄存在显着差异，病变范围,两组间的脑电图放电。在最后一次随访中（中位数为14.1年），癫痫发作自由率(81.6%vs.57.1%,p=0.032)和ASM停药(44.4%与6.3%,p=0.006）手术组高于非手术组。手术组患者完全切除/断流的癫痫发作发生率高于次全切除（87.5％vs.55.6%,p=0.078),但没有统计学上的显著差异。在非手术组中，更广泛的病变与更差的癫痫发作结局相关.90％的手术患者术后认知改善。
结论：在单侧多叶和半球PMG患者中，癫痫发作的年龄，病变的范围和脑电图特征可以帮助确定是否应尽早进行手术。此外,手术可能更有利于更快地实现癫痫发作自由和认知改善。
结论：我们的目的是总结临床特征，并比较手术和非手术（ASM）治疗后的长期结局，为单侧多叶和半球多微癫痫（PMG）相关癫痫患者的治疗决策提供依据。我们发现，与非手术治疗相比，单侧半球和多叶PMG患者的癫痫发作自由和ASM停药率明显更高。在手术组中，完全切除/断流治疗的患者的癫痫发作结局优于次全切除治疗的患者。但差异无统计学意义。
方法：我们检索了2022年9月之前发表的与单侧多叶和半球PMG相关的研究，包括过去10年在北京大学第一医院小儿癫痫中心随访的患者。我们总结了临床特征，并比较了手术或非手术后的长期结局（抗癫痫药物，ASM)治疗。
结果：共有70例患者（49例手术，包括21个非手术）的单侧多叶和半球PMG。癫痫发作的中位年龄为2.5岁（1.0-4.1）。最常见的癫痫发作类型是局灶性和非典型失神发作。在整个队列中，在缓慢睡眠（ESES）期间，有87.3％的偏瘫和67.1％的癫痫持续状态。癫痫发作的年龄存在显着差异，病变范围,两组间的脑电图放电。在最后一次随访中（中位数为14.1年），癫痫发作自由率(81.6%vs.57.1%,p=0.032)和ASM停药(44.4%与6.3%,p=0.006）手术组高于非手术组。手术组患者完全切除/断流的癫痫发作发生率高于次全切除（87.5％vs.55.6%,p=0.078),但没有统计学上的显著差异。在非手术组中，更广泛的病变与更差的癫痫发作结局相关.90％的手术患者术后认知改善。
结论：在单侧多叶和半球PMG患者中，癫痫发作的年龄，病变的范围和脑电图特征可以帮助确定是否应尽早进行手术。此外,手术可能更有利于更快地实现癫痫发作自由和认知改善。
结论：我们的目的是总结临床特征，并比较手术和非手术（ASM）治疗后的长期结局，为单侧多叶和半球多微癫痫（PMG）相关癫痫患者的治疗决策提供依据。我们发现，与非手术治疗相比，单侧半球和多叶PMG患者的癫痫发作自由和ASM停药率明显更高。在手术组中，完全切除/断流治疗的患者的癫痫发作结局优于次全切除治疗的患者。但差异无统计学意义。
