局灶性皮质发育不良所致癫痫手术预后的影响因素分析

摘要

目的 探讨影响局灶性皮质发育不良(FCD)致癫痫患者手术预后的相关因素.方法 回顾性分析42例FCD致癫痫手术治疗患者的临床资料,FCD均经术后病理证实.术后随访12~36个月,进行Engel分级评定患者的预后;应用Logistic回归分析探讨影响手术预后的相关因素.结果 术后EngelⅠ级者27例(64.3%),Ⅱ级者6例(14.3%),Ⅲ级者6例(14.3%),Ⅳ级者3例(7.1%).Logistic回归分析显示,MEG定位致痫灶与手术范围不一致[OR值6.063,95%可信区间(CI)1.168~31.482)]和致痫灶未完全切除(OR值7.739,95%CI 1.447~41.398)是影响FCD致癫痫患者手术预后的独立危险因素(均P<0.05).而性别、年龄、病程、有无高热惊厥史、致痫灶位置、头颅MRI是否阳性、病理分型对手术预后的影响均无统计学意义.结论 发作间期MEG定位致痫灶与手术范围的一致性,以及致痫灶完全切除与FCD致癫痫患者的手术预后良好有关.%Objective To investigate the prognostic factors of surgical operation in patients with epilepsy induced by focal cortical dysplasia (FCD).Methods The clinical data of 42 patients with epilepsy induced by pathological proved FCD,were analyzed retrospectively.Postoperative follow-up for 12 to 36 months,Engel classification of assessing the prognosis of patients,application of Logistic regression analysis to investigate the factors influencing the prognosis of surgery.Results 27 patients(64.3%)were Engel classⅠ,6 patients(14.3%)were Engel classⅡ,6 patients(14.3%)were Engel classⅢ,3 patients(7.1%)were Engel class Ⅳ.Logistic regression showed that inconsistency of MEG and surgical range(OR=6.063,95%CI 1.168-31.482,P<0.05)and incomplete resection(OR=7.739,95%CI 1.447-41.398,P<0.05)were independent prognostic factors.Gender,age,course of disease,the history of febrile seizure,the location of epileptogenic zone,brain MRI and type of FCD were not statistically significant.Conclusion The operative prognoses of the patients with epilepsy induced by FCD are associated with consistency of MEG and surgical range,complete resection of epileptogenic zone.