目的:本研究的目的是描述一组在5岁之前接受了耐药性癫痫(DRE)手术的患者的术前和术后发育和智力功能。
方法:我们回顾性回顾了80例接受手术治疗的DRE儿科患者的医疗记录和神经发育评估。我们纳入患者,如果他们至少有一个术前和术后神经心理学评估;27符合纳入标准。我们评估了手术前后的发育商(DQ)和智商(IQ)。我们根据心理评估结果确定了两组:第1组,具有稳定或改善的发育和智力功能,和第2组,经历发育和智力损失。
结果:癫痫发作的平均年龄为1.2±1.0岁,手术时的平均年龄为2.9±1.2岁。在最后一次随访中(平均4年,SD±2),19/27(70%)患者无癫痫发作和药物;18/27(67%)患者符合第1组,9/27(33%)符合第2组。第1组的手术平均年龄为2.6岁(SD±1.1;范围1.2-5.1),第2组为3.4岁(SD±1.1;范围1.6-5.0)。第1组术前DQ/IQ总分低于第2组(中位DQ/IQ分别为82vs108,p=0.05)。在评估前和评估后之间,我们发现,在第1组中,绩效得分提高(82.7vs102,p=0.001),而在第2组中,总评分和言语评分恶化(分别为108vs75,p=0.008和100vs76,p=0.021)。
结论:我们的研究结果强调了5岁前手术对发育和智力结果的积极影响。尽管限制,如样本量小,缺少对照组,和不同的病因,我们的研究结果支持早期干预在保护或增强年轻DRE患者的发育和智力功能方面的关键作用.
结论:这项回顾性研究,在意大利BambinoGesu儿童医院进行,报告接受早期癫痫手术的儿童(5岁之前)的神经心理学和发育和/或认知数据。研究发现,发育或认知特征较低的儿童在术后神经心理学评估中得分最高。这项研究提供了早期手术在缩短癫痫持续时间方面的潜在益处的信息,防止或阻止恶化,增强可塑性和恢复性。
OBJECTIVE: The aim of this study is to describe the pre- and post-operative developmental and intellectual functions in a cohort of patients who underwent surgery for drug-resistant epilepsy (DRE) before the age of 5 years.
METHODS: We retrospectively reviewed the medical records and neurodevelopmental assessments of a cohort of 80 surgically treated pediatric patients with DRE. We included patients if they had at least one pre- and one post-surgical neuropsychological assessments; 27 met the inclusion criteria. We evaluated Developmental Quotient (DQ) and Intelligence Quotient (IQ) before and after surgery. We identified two groups based on psychological evaluation outcome: Group 1, with stable or improved developmental and intellectual functions, and Group 2, experiencing developmental and intellectual loss.
RESULTS: The mean age at seizure onset was 1.2 ± 1.0 years, and the mean age at surgery was 2.9 ± 1.2 years. At the last follow-up (mean 4 years, SD ± 2), 19/27 (70%) patients were seizure- and drug-free; 18/27 patients (67%) fit in Group 1, and 9/27 (33%) fit in Group 2. The mean age at surgery was 2.6 years (SD ± 1.1; range 1.2-5.1) in Group 1 and 3.4 years in Group 2 (SD ± 1.1; range 1.6-5.0). Group 1 had a lower pre-operative DQ/IQ total score than Group 2 (median DQ/IQ respectively 82 vs 108, p = 0.05). Between pre- and post-assessments, we found that in Group 1, Performance scores improved (82.7 vs 102, p = 0.001), while in Group 2, the Total and Verbal scores worsened (respectively 108 vs 75, p = 0.008, and 100 vs 76, p = 0.021).
CONCLUSIONS: Our study\'s results emphasize the positive impact of surgery before the age of 5 years on developmental and intellectual outcomes. Despite limitations such as a small sample size, lack of a control group, and diverse etiologies, our findings support the crucial role of early intervention in preserving or enhancing developmental and intellectual functions in young patients with DRE.
CONCLUSIONS: This retrospective study, conducted at the Bambino Gesù Children Hospital in Italy, reports neuropsychological and developmental and/or cognitive data for children undergoing early epilepsy surgery (before the age of 5). It found that children with lower developmental or cognitive profiles gained the highest scores on post-operative neuropsychological evaluations. This study provides information on the potential benefits of early surgery in shortening the duration of epilepsy, preventing or arresting deterioration, and enhancing plasticity and recovery.