生命前六个月的癫痫手术：系统评价和荟萃分析。,Seizure: European Journal of Epilepsy

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生命前六个月的癫痫手术：系统评价和荟萃分析。
Seizure: European Journal of Epilepsy ( IF 2.7 ) Pub Date : 2022-02-17 , DOI: 10.1016/j.seizure.2022.02.009
Konstantin L Makridis ₁ , Deniz A Atalay ₂ , Ulrich-Wilhelm Thomale ₃ , Anna Tietze ₄ , Christian E Elger ₅ , Angela M Kaindl ₁

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引言近三分之一的癫痫患儿发展为耐药性癫痫。尽管癫痫手术在所有年龄组中都是一种成熟的治疗方法，但由于独特的手术和麻醉困难，可能不愿意在婴儿出生后的前六个月对婴儿进行手术。方法我们进行了一项荟萃分析和系统评价，以评估在 ≤ 6 个月的婴儿中进行癫痫手术的结果和并发症发生率。结果 158 名婴儿接受了癫痫手术，最常见的是半球切开术而不是局灶性手术。手术后总体无癫痫发作率为 65.6% [CI: 0.5785; 0.7261]，半球切开术后的无癫痫发作率（71%）高于局灶性手术后的无癫痫发作率（58%）。并发症发生率为 27.7% [0.1794; 0.4004] 的患者。最普遍的是，136 例中有 20 例（14.71%）出现脑积水。21.5% [0.1431; 抗癫痫药物 (ASM) 停用；0.3100] 并减少 85.9% [0.515; 0.9721] 93 例患者术后。84.6% 的婴儿在术前表现出认知障碍（发育商 (DQ) <85）。手术后，有一种认知增益的趋势。然而，认知增益几乎只见于无癫痫发作的患者。讨论在生命的头六个月内通过癫痫手术可以实现出色的癫痫发作控制，大部分患者能够减少或停止 ASM。关于认知结果的数据是有希望的，但也表明主要目标应该是实现无癫痫发作。鉴于手术条件比较困难，

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Epilepsy surgery in the first six months of life: A systematic review and meta-analysis.

INTRODUCTION Nearly one-third of all infants with epilepsy develop drug-resistant epilepsy. Although epilepsy surgery is a well-established therapy across all age groups, there might be a reluctance to operate on infants in the first six months of life due to unique surgical and anesthesiologic difficulties. METHODS We performed a meta-analysis and systematic review to assess the outcome and complication rate of epilepsy surgery in infants operated on ≤ six months of life. RESULTS 158 infants underwent epilepsy surgery, most frequently a hemispherotomy rather than focal surgery. Overall seizure freedom after surgery was 65.6% [CI: 0.5785; 0.7261], with higher seizure-free rates following hemispherotomy (71%) than after focal surgery (58%). Complications occurred in 27.7% [0.1794; 0.4004] of patients. Most prevalently, a hydrocephalus developed in 20 out of 136 cases (14.71%). Anti-seizure medication (ASM) was discontinued in 21.5% [0.1431; 0.3100] and reduced in 85.9% [0.515; 0.9721] of 93 patients postoperatively. 84.6% of infants displayed cognitive impairment (development quotient (DQ) <85) preoperatively. After surgery, there was a trend toward a cognitive gain. However, cognitive gain was seen almost exclusively in seizure-free patients. DISCUSSION Excellent seizure control can be achieved with epilepsy surgery in the first six months of life, a large proportion of patients are able to reduce or discontinue ASM. Data regarding cognitive outcome are promising, but also show that the primary goal should be to achieve seizure freedom. Given the more difficult surgical conditions, epilepsy surgery in the first six months of life should only be performed in specialized epilepsy centers.

更新日期：2022-02-17

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