背景:在非洲,癫痫是一个真正的负担。颞叶癫痫是最常见的耐药局灶性癫痫,颞叶切除术是耐药性癫痫患者最常见的有效治疗方法。
目的:我们的目标是强调摩洛哥在癫痫手术中的经验,并确定其长期结果。通过我们系列的手术治疗结果,我们希望提高人们对非洲癫痫手术需求的认识,并为其发展做出贡献。
方法:我们对我们机构2005年1月至2021年12月接受癫痫手术的132例患者进行了回顾性研究。术前评估基于临床筛查,发作间脑电图,VEEG,神经心理学测试,MRI和宠物扫描在某些情况下。数据表示为中值和范围。对于所有分析,P值<0.05被认为具有统计学意义。
结果:我们的系列包括132名患者(69名男性,52.27%),手术年龄中位数为24岁(范围:1~64岁).115例患者(87%)因颞叶癫痫手术,其中,98例(85%)进行了颞叶前叶切除术,17人(15%)接受了病灶切除术。17名患者(13%)接受了颞外癫痫手术,其中,4人进行了病灶切除术,7功能性半球切开术,5例患者接受了伽玛刀立体定向放射手术。我们的术后结果在手术后3个月发现113例患者(85.6%),无癫痫(EngelI),16恩格尔二世(12.1%),颞叶癫痫中的3例EngelIII(2.3%)。在颞叶外叶癫痫中,12人(70.5%)是恩格尔一世,无癫痫,4恩格尔II(23.5%)和1恩格尔III(6%)。
结论:这些结果证实,大多数耐药癫痫患者可以在不接受术前侵入性探查的情况下从手术治疗中获益。这应该有助于在非洲广泛发展癫痫手术。
In Africa, epilepsy is a real burden. Temporal lobe epilepsy is the most common drug-resistant focal epilepsy disorder, and temporal lobectomy is the most common effective treatment for patients with drug-resistant epilepsy.
We aim to highlight the Moroccan experience in epilepsy surgery and to ascertain its long-term outcome. Through the results of surgical treatment in our series, we hope to raise awareness of the need for epilepsy surgery in Africa and contribute to its development.
We present a retrospective study of 132 patients who underwent surgery for epilepsy from January 2005 to December 2021 at our institution. The presurgical evaluation was based on clinical screening, interictal electroencephalography, video-electroencephalography, neuropsychological tests, magnetic resonance imaging, and positron emission tomography in some cases. Data are presented as the median and ranges. For all analyses, P values <0.05 were considered statistically significant.
Our series includes 132 patients (69 males; 52.27%); the median age at surgery was 24 years (range, 1-64). One hundred and fifteen patients (87%) were operated on for temporal lobe epilepsy, of whom 98 (85%) had anterior temporal lobectomy and 17 (15%) had lesionectomy. Seventeen patients (13%) were operated on for extratemporal epilepsy, of whom 4 had lesionectomy, 7 functional
hemispherotomy, and 5 Gamma Knife stereotactic radiosurgery. Our postoperative outcomes 3 months after surgery found 113 patients (85.6%) seizure-free (Engel class I), 16 with Engel class II (12.1%), and 3 with Engel class III (2.3%) in temporal lobe epilepsy. In extratemporal lobe epilepsy, 12 patients (70.5%) showed Engel class I, seizure-free, 4 Engel class II (23.5%), and 1 Engel class III (6%).
These results confirm that most patients with drug-resistant epilepsy may benefit from surgical treatment without submitting to preoperative invasive explorations. This finding should help develop epilepsy surgery widely in Africa.