幕上神经胶质瘤相关性癫痫发作模式的危险因素分析  

Risk factors for supratentorial glioma-associated seizure patterns

作　　者：张杰[1] 吴建兵 杜春富 张德明[1] 高晋健 冯文 王嗣松 张桓 ZHANG Jie;WU Jian-bing;DU Chun-fu;ZHANG De-ming;GAO Jin-jian;FENG Wen;WANG Si-song;ZHANG Huan(Department of Neurosurgery,Yaan People’s Hospital,Yaan 625000,Sichuan,China;Department of Neurosurgery,Chengdu West District Hospital,Southwest Medical University,Chengdu 610036,Sichuan,China;Department of Neurosurgery,Chengdu 363 Hospital,Southwest Medical University,Chengdu 610041,Sichuan,China)

机构地区：[1]雅安市人民医院神经外科,雅安625000 [2]西南医科大学附属成都市西区医院神经外科,成都610036 [3]西南医科大学附属成都三六三医院神经外科,成都610041

出　　处：《中国临床医学》2019年第5期745-749,共5页Chinese Journal of Clinical Medicine

基　　金：四川省科技支撑计划项目(2011FZ0032)~~

摘　　要：目的:探讨幕上神经胶质瘤相关性癫痫患者术后对抗癫痫治疗的反应。方法:回顾性分析2014年1月至2018年1月在雅安市人民医院就诊的234例幕上神经胶质瘤相关性癫痫患者的临床资料。术后癫痫发作模式包括无癫痫发作,早期发作(术后早期癫痫发作控制在6个月内),波动性发作,持续发作(未获得无癫痫发作)。分析4种模式患者无癫痫发作率、无发作持续时间及随后的复发率。结果:纳入患者中,无癫痫发作119例(50.9%),早期发作29例(12.4%),波动性发作56例(23.9%),持续发作30例(12.8%)。胶质瘤病理分级Ⅱ级71例(30.3%),Ⅲ级41例(17.5%),Ⅳ级122例(52.1%)。与无癫痫发作相比,早期发作患者组织学进展明显(P<0.05),波动性发作患者肿瘤分级更高、术前癫痫发作更常见、组织学进展更明显(P<0.05),持续发作患者术前癫痫发作、肿瘤切除不完全多见(P<0.05)。经历12个月的癫痫发作缓解后,分别有39.4%、63.4%和15.6%的Ⅱ、Ⅲ和Ⅳ级胶质瘤患者出现癫痫发作。结论:幕上神经胶质瘤相关性癫痫患者术后癫痫发作具有特定的风险因素;Ⅱ~Ⅲ级胶质瘤患者术后以癫痫波动性发作最常见,12个月的无癫痫发作后常复发;术前癫痫发作、肿瘤切除不足是从未获得无发作的风险因素。Objective: To investigate the response to postoperative anti-epilepsy treatment in patients with supratentorial glioma-related epilepsy. Methods: Clinical data of 234 patients with supratentorial glioma-related epilepsy from January 2014 to January 2018 were retrospectively analyzed. Postoperative seizure patterns include: no postoperative seizure;early postoperative seizure controlled within 6 months;fluctuating seizure;and never seizure-free. No seizure rate, no seizure duration, and subsequent recurrence rate were analyzed. Results: Among the patients, there were 119 cases (50.9%) without seizure, 29 cases (12.4%) with early seizure, 56 cases (23.9%) with fluctuating seizure, and 30 cases (12.8%) with persistent seizure. There were 71 cases (30.3%) of glioma pathological grade Ⅱ, 41 cases (17.5%) of grade Ⅲ, and 122 cases (52.1%) of grade Ⅳ. Compared with patients without seizure, histology of patients with early seizure progressed significantly ( P <0.05). In patients with fluctuating seizure, the pathological level of tumor was higher, and preoperative seizures were more common and histological progress was more obvious ( P <0.05). In patients with persistent seizures,preoperative epilepsy seizures and incomplete tumor resection were commmon ( P <0.05). After 12 months of seizure relief, 39.4%, 63.4%, and 15.6% of grade Ⅱ,Ⅲ, and Ⅳ glioma patients experienced subsequent seizures respectively. Conclusions: Epilepsy after surgery in supratentorial glioma-associated epilepsy patients has specific risk factors. Patients with grade Ⅱ-Ⅲ gliomas are most likely to have epileptic seizures after surgery, and no seizure occurred with 12 months and then offen relapsed to grade Ⅱ-Ⅲ gliomas. The risk factors for never seizure-free are preoperative seizures and insufficient tumor resection.

关 键 词：胶质瘤 肿瘤相关性癫痫 药物治疗 癫痫发作 

分 类 号：R739.41[医药卫生—肿瘤]