背景:切除与难治性癫痫相关的脑损伤以控制癫痫发作是公认的。然而,这些病变的并发行为影响,如情绪变化,个性,认知和手术对行为的影响还没有得到很好的表征。我们描述了5例此类癫痫性病变和明显的行为异常患儿,这些患儿在手术后有所改善。
方法:在我们中心确定并治疗了5名患有主要行为异常和病灶性癫痫的儿童(3-14岁)。行为问题包括学术障碍,冲动,自我伤害的行为,与多动症诊断的社交互动减少,对立的反抗障碍,和自闭症。在4/5的患者中进行了术前神经精神测试,显示他们年龄的平均认知和智力能力较低,注意困难,和糟糕的记忆。病变位于颞叶(2个神经节胶质瘤,1JPA,1个海绵体瘤)和顶叶(1个DNET)叶。在所有情况下都实现了总切除。平均随访1年,癫痫发作自由(恩格尔1a在3例患者中,2例患者的Engel1c)和显著的行为改善(学业成绩,注意,社会化,和侵略)在所有方面都实现了。两名患者在术前表现出暴力;尽管癫痫发作负担较低,但其中一人对教师和同伴表现出极端的暴力行为。手术后,他的行为已经正常化。
结论:我们确定了5名患有严重行为障碍的病灶性癫痫患者,所有这些人在手术后都表现出改善。行为异常程度与癫痫严重程度不成比例,这表明病灶性癫痫影响行为的机制更为复杂。我们提出了一种新的范例,即使在癫痫发作不是难治性的情况下,病灶切除术也可以提供行为益处。因此,行为改善可能是癫痫性脑损伤患儿神经外科手术切除的重要新目标。
BACKGROUND: Resection of brain lesions associated with refractory epilepsy to achieve seizure control is well accepted. However, concurrent behavioral effects of these lesions such as changes in mood, personality, and cognition and the effects of surgery on behavior have not been well characterized. We describe 5 such children with epileptogenic lesions and significant behavioral abnormalities which improved after surgery.
METHODS: Five children (ages 3-14 years) with major behavioral abnormalities and lesional epilepsy were identified and treated at our center. Behavioral problems included academic impairment, impulsivity, self-injurious behavior, and decreased social interaction with diagnoses of ADHD, oppositional defiant disorder, and autism. Pre-operative neuropsychiatric testing was performed in 4/5 patients and revealed low-average cognitive and intellectual abilities for their age, attentional difficulties, and poor memory. Lesions were located in the temporal (2 gangliogliomas, 1 JPA, 1 cavernoma) and parietal (1 DNET) lobes. Gross total resection was achieved in all cases. At mean 1-year follow-up, seizure freedom (Engel 1a in 3 patients, Engel 1c in 2 patients) and significant behavioral improvements (academic performance, attention, socialization, and aggression) were achieved in all. Two patients manifested violence pre-operatively; one had extreme behavior with violence toward teachers and peers despite low seizure burden. Since surgery, his behavior has normalized.
CONCLUSIONS: We identified 5 patients with severe behavioral disorders in the setting of lesional epilepsy, all of whom demonstrated improvement after surgery. The degree of behavioral abnormality was disproportionate to epilepsy severity, suggesting a more complicated mechanism by which lesional epilepsy impacts behavior. We propose a novel paradigm in which lesionectomy may offer behavioral benefit even when seizures are not refractory. Thus, behavioral improvement may be an important novel goal for neurosurgical resection in children with epileptic brain lesions.