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儿童耐药性癫痫的手术治疗
Surgery for Drug-Resistant Epilepsy in Children


Rekha Dwivedi ... 妇产科和儿科 • 2017.10.26

摘要


背景

神经外科治疗可能改善患耐药性癫痫儿童和青少年的癫痫发作,但还需要更多的随机试验数据。

 

方法

在这项单中心试验中,我们将116例18岁或18岁以下的耐药性癫痫患者随机分为两组,一组在适当药物治疗的同时接受针对其癫痫病因的合适脑部手术(手术组,57例患者),另一组仅接受药物治疗(药物治疗组,59例患者)。将药物治疗组的患者列入等候手术的名单。主要结局是12个月时无癫痫发作。次要结局是海牙癫痫发作严重程度量表(Hague Seizure Severity Scale)评分、Binet-Kamat智商、威尼兰社会成熟度量表(Vineland Social Maturity Scale)中的社交商以及儿童行为检查表(Child Behavior Checklist)和儿童生活质量测定量表(Pediatric Quality of Life Inventory)的评分。

 

结果

12个月时,手术组和药物治疗组分别有44例(77%)和4例(7%)患者无癫痫发作(P<0.001)。对于以下各项评分从基线至12个月的变化,手术组显著优于药物治疗组:海牙癫痫发作严重程度量表评分(差值,19.4;95%置信区间[CI],15.8~23.1;P<0.001)、儿童行为检查表评分(差值13.1;95% CI,10.7~15.6;P<0.001)、儿童生活质量测定量表评分(差值,21.9;95% CI,16.4~27.6;P<0.001)和威尼兰社会成熟度量表评分(差值,4.7;95% CI,0.4~9.1;P=0.03)。但Binet-Kamat智商的变化无显著组间差异(差值2.5;95% CI,−0.1~5.1;P=0.06)。手术组19例患者(33%)出现严重不良事件,其中15例(26%)为轻偏瘫。

 

结论

在这项对耐药性癫痫儿童和青少年患者开展的单中心试验中,接受了癫痫手术的患者12个月时无癫痫发作的比例以及行为和生活质量方面的评分显著高于仅持续接受药物治疗的患者。手术导致了与相关脑区域切除有关的神经功能缺陷,这是在预期之内的(由印度医学研究委员会[Indian Council of Medical Research]等资助;在印度临床研究注册系统 [Clinical Trial Registry-India] 的编号为CTRI/2010/091/000525)。





作者信息

Rekha Dwivedi, Ph.D., Bhargavi Ramanujam, M.D., D.M., P. Sarat Chandra, M.Ch., Savita Sapra, Ph.D., Sheffali Gulati, M.D., D.M., Mani Kalaivani, Ph.D., Ajay Garg, M.D., Chandra S. Bal, M.D., Madhavi Tripathi, M.D., Sada N. Dwivedi, Ph.D., Rajesh Sagar, M.D., Chitra Sarkar, M.D., and Manjari Tripathi, M.D., D.M.
From the Departments of Neurology (R.D., B.R., Manjari Tripathi), Neurosurgery (P.S.C.), Pediatrics (S.S., S.G.), Biostatistics (M.K., S.N.D.), Neuro-Radiology (A.G.), Nuclear Medicine (C.S.B., Madhavi Tripathi), Psychiatry (R.S.), and Pathology (C.S.), All India Institute of Medical Sciences, New Delhi, India. Address reprint requests to Dr. Manjari Tripathi at the Department of Neurology, All India Institute of Medical Sciences, Center of Excellence for Epilepsy and Magnetoencephalography Center, New Delhi, India 110029, or at mtripathiaiims@gmail.com.

 

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