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目的总结外科手术治疗27例小儿难治性癫痫综合征病人的经验。方法术前评估和术中脑电检查显示为局灶性改变者行致痫灶切除、脑叶切除或多软膜下横纤维切断(MST)。检查提示一侧半球为主多灶性改变者,术中行多脑叶切除联合MST或(和)胼胝体部分切开。结果本组随访1-8年,平均4.5年。27例病人中有14例获得Ⅰ级(Engel分级),8例获得Ⅱ级,3例为Ⅲ级。平均智商(IQ)从术前的61.4分提高到75.0分,癫痫病程和术前药物难治的时间越短,智商改善越明显。本组4例病人出现暂时性的并发症,无手术死亡。结论对小儿难治性癫痫综合征进行早期外科干预,可以有效地控制癫痫发作、改善智力损害和避免生活残疾。
Objective To summarize the experience of surgical treatment of 27 children with refractory epilepsy syndrome. Methods Preoperative evaluation and intraoperative EEG examination showed focal changes in patients with epileptogenic resection, lobectomy, or multiple subdural transection (MST). Check to remind the hemisphere-based multifocal change, intraoperative multi-lobectomy combined MST or () and corpus callosum partial incision. Results The group was followed up for 1-8 years, an average of 4.5 years. Fourteen of the 27 patients had grade I (Engel grade), eight received grade II and three had grade III. The mean IQ (IQ) increased from 61.4 points preoperatively to 75.0 points. The shorter the duration of epilepsy and refractory period of preoperative medication, the more obvious the improvement of IQ. 4 patients in this group of patients with temporary complications, no operative death. Conclusion Early surgical intervention in children with refractory epilepsy syndrome can effectively control seizures, improve intellectual impairment and avoid life disability.