目的:评估癫痫发作和发育结果,他们的预测因素,以及160名儿童的并发症,在1998年至2022年期间,患者在3岁之前接受了有治愈意向的病灶性癫痫手术.比较2014年前后该年龄组癫痫手术的趋势。
方法:回顾性多中心研究。描述性和单变量分析,和所有结果的多变量模型。
结果:这160例患者(76华氏度;47.5%)接受了169例手术(手术年龄20.4±9.4个月)。末次随访(77±57.4个月),121例患者(75.6%)为EngelI级,其中106人(66.2%)属于EngelIa级。84例患者(52.5%)停止服用抗癫痫药物。在16例患者中观察到需要再次手术的并发症(10%;9.5%的手术),在12例患者中观察到意外的永久性缺陷(7.5%;7.1%的手术)。56例(44.4%)患者术后认知功能未变,提高51(40.5%),19年恶化(15.1%)。多变量分析表明,当癫痫持续时间较长时,达到EngelIa级的概率较低,患者接受术前视频脑电图,和意外的术后永久性缺陷发生。术后认知改善与术前癫痫发作频率降低相关,更好的术前发育水平,和更长时间的术后随访。FCDII和肿瘤是组织病理学携带更高的概率实现癫痫发作的自由,而多微与认知改善的可能性较低有关。2014年后接受手术的患者数量高于以往(61.3%vs.38.7%),结果稳定。
结论:癫痫手术对婴幼儿是有效和安全的,尽管并发症发生率高于老年患者。癫痫持续时间较短,较低的癫痫发作频率,不需要视频脑电图,肿瘤,某些皮质发育畸形是癫痫发作和认知结局的有力预测因子,可用于增加早期转诊.
结论:这项研究分析了1998年至2022年间在四个意大利中心进行的160名3岁之前接受手术的儿童的癫痫手术结果。末次随访(77±57.4个月),121例患者(75.6%)无致残性癫痫发作,其中106例(66.2%)手术后完全无癫痫发作。28例(17.5%)患者发生重大手术并发症,比一般癫痫手术观察到的要高,但类似于半球/多叶手术。56例(44.4%)患者术后认知功能无变化,提高51(40.5%),19年恶化(15.1%)。癫痫手术对婴儿和幼儿是有效和安全的。
OBJECTIVE: To assess seizure and developmental outcomes, their predictors, and complications in 160 children who, between 1998 and 2022, underwent surgery for lesional epilepsy with curative intent before the age of 3 years. To compare trends in epilepsy surgery in this age group before and after the year 2014.
METHODS: Retrospective multicenter study. Descriptive and univariate analyses, and multivariable models for all outcomes.
RESULTS: These 160 patients (76 F; 47.5%) underwent 169 surgeries (age at surgery 20.4 ± 9.4 months). At the last follow-up (77 ± 57.4 months), 121 patients (75.6%) were in Engel class I, 106 (66.2%) of whom were in Engel class Ia. Antiseizure medications were stopped in 84 patients (52.5%). Complications requiring reoperations were observed in 16 patients (10%; 9.5% of surgeries) and unexpected permanent deficits in 12 (7.5%; 7.1% of surgeries). Postoperative cognitive functions remained unchanged in 56 patients (44.4%), improved in 51 (40.5%), and worsened in 19 (15.1%). Multivariable analyses showed that the probability of achieving Engel class Ia was lower when the duration of epilepsy was longer, patients underwent preoperative video-EEG, and unexpected postoperative permanent deficits occurred. Cognitive improvement after surgery was associated with lower preoperative seizure frequency, better preoperative developmental level, and a longer postoperative follow-up. FCDII and tumors were the histopathologies carrying a higher probability of achieving seizure freedom, while polymicrogyria was associated with a lower probability of cognitive improvement. The number of patients operated on after 2014 was higher than before (61.3% vs. 38.7%), with stable outcomes.
CONCLUSIONS: Epilepsy surgery is effective and safe in infants and toddlers, although the complication rate is higher than seen in older patients. Shorter duration of epilepsy, lower seizure frequency, no need for video-EEG, tumors, and some malformations of cortical development are robust predictors of seizure and cognitive outcome that may be exploited to increase earlier referral.
CONCLUSIONS: This study analyzed the results of epilepsy surgery in 160 children who had been operated on before the age of 3 years at four Italian centers between 1998 and 2022. At the last follow-up (77 ± 57.4 months), 121 patients (75.6%) were free from disabling seizures, of which 106 (66.2%) were completely seizure-free since surgery. Major surgical complications occurred in 28 patients (17.5%), which is higher than observed with epilepsy surgery in general, but similar to hemispheric/multilobar surgery. Postoperative cognitive function remained unchanged in 56 patients (44.4%), improved in 51 (40.5%), and worsened in 19 (15.1%). Epilepsy surgery is effective and safe in infants and toddlers.