局灶性皮质发育不良Ⅰ型的临床特征和手术预后因素分析  

Clinical features and prognosticators for surgical outcomes of focal cortical dysplasia type Ⅰ

作　　者：陈凯[1] 栾国明[1] 关宇光[1] 周健[1] 刘长青[1] 

机构地区：[1]北京三博脑科医院(首都医科大学第十一临床医学院)功能神经外科、癫痫临床医学研究北京市重点实验室、北京脑重大疾病研究院癫痫所,100093

出　　处：《中华神经外科杂志》2015年第4期354-357,共4页Chinese Journal of Neurosurgery

基　　金：国家科技部支撑计划项目（2012BAl03802）;“首都临床特色应用研究”专项（Z131110700220000）;北京市科技新星计划（Z141107001814042）;“首都临床特色应用研究”专项（Z1311070（Y2213171）;北京市自然科学基金（7144217）

摘　　要：目的 探讨局灶性皮质发育不良（FCD）Ⅰ型癫痫患者的临床特征和手术预后因素.方法 回顾性分析2008年4月至2013年12月在北京三博脑科医院癫痫中心病理证实的99例FCDⅠ型患者的临床特征、术前检查结果和术后Engel Ⅰ级率之间的关系,得出有预后价值的因素.其中,FCD Ⅰ a型29例,FCD Ⅰ b型54例,FCD Ⅰ c型16例.结果 63例患者术后1年达到Engel Ⅰ级.起病年龄＞6岁、非药物难治性、发作频率＜1次/周、间歇期脑电图（EEG）呈局灶性、明显的MRI异常和无围手术期发作的患者均有较高的Engel Ⅰ级率（P＜0.05）.结论 FCD Ⅰ型癫痫患者对其手术效果预后价值的临床特征有起病年龄、年龄、非药物难治性、发作频率、间歇期EEG表现、MRI异常程度和是否围手术期发作,而MRI上无明显病变、间歇期脑电图呈非局灶放电和术后围手术期有癫痫发作是术后1年癫痫复发的危险因素。Objective To analyze the clinical features of patients with focal cortical dysplasia type Ⅰ （FCD type Ⅰ） and explore the prognostic factors for the surgical outcomes.Methods This article retrospectively analyzed the pre-and surgical data and the outcomes by Engel scale of 99 histopathologically confirmed FCD type Ⅰ patients,including age at surgery,age at seizure onset,seizure related risks like febrile convulsion and pre-or peri-natal adverse events,seizure frequency,response to medicine,inter-and ictal-EEG pattern,lesion discernibility and extension on MRI,site of surgery and completeness of section based on MRI,recurrence of seizure during perioperative period and pathological subtypes rediagnosed by ILAE2011 classification.Results FCD subtype Ⅰ a was identified in 29,Ⅰ b in 54,and Ⅰ c in 16.There was no significant difference on clinical features between different subtypes.Engel class Ⅰ was achieved in 64% patients,and was 64%,67% and 50% in FCD Ⅰ a,Ⅰ b and Ⅰ c （with no significance between subtypes,chi-square test）.Those with a history of febrile convulsion or pre-and peri-natal adverse events showed an earlier age of onset than patients without such histories （7.3 ± 6.9 years and 6.5 ± 7.2 years vs 12.6±8.9 years,P =0.035 and P =0.005,LSD method）.Patients with age of onset 〉6 years old presented a higher Engel class Ⅰ rate than those with age of onset ≤6 years old （45/63 vs 18/36,P =0.033,chi-square test）.The same statistically significantly higher Engel class Ⅰ rates were observed in patient with medically non-refractory seizures than those with refractory seizures （28/36 vs 35/63,P =0.027,chi-square test）.The seizure frequency less than and more than once per week （29/37 vs 34/62,P =0.018,chi-square test）,focal than non-focal interictal EEG pattern （35/46 vs 28/53,P =0.016,chi-square test）,obvious than subtle/negative lesion on MRI （37/49 vs 26/50,P =0.015,chi-square test）,and without than with perioperative seizure recurrence （53/73 vs 10/2

关 键 词：癫痫 皮质发育畸形 Ⅰ型 疾病特征 神经外科手术 预后 

分 类 号：R651.1[医药卫生—外科学]