【摘要】 目的探讨难治性癫痫患儿外科手术治疗前后认知功能的变化。方法 27例儿童难治性癫痫患儿通过结构功能影像学、头皮长程视频脑电图(VEEG),需要时行侵入性脑电图(iEEG)等全面评估后个体化选择癫痫外科手术,于术前7天、术后3个月、6个月及12个月分别采用韦氏儿童智力量表第四版中文版(WISC-Ⅳ)测试患儿认知功能,评价手术前后认知功能,术后采用Engel分级评价手术治疗效果。结果 27例难治性癫痫儿童,术后随访12～36个月(平均随访22个月),17例患儿术后完全无癫痫发作,5例患儿术后发作极少,1年中仅1次,发作频率减少超过90%有3例,2例癫痫发作控制改善不明显,发作频率及症状未见明显改善。27例患儿配合完成了韦氏儿童智力量表第四版中文版(WISC-Ⅳ)测验,癫痫外科手术治疗后12个月患儿智商相比术前增加2.00～12.00(6.70±2.45)分(P<0.001),认知功能改善有统计学意义,且开颅手术与迷走神经刺激术对患者认知功能影响的差异之间无统计学意义(P>0.05)。结论癫痫外科手术对于难治性癫痫儿童安全且有效,可控制或减少术后发作频率,难治性癫痫儿童术后认知功能有不同程度提高。更多还原

【Abstract】 Objective Refractory epilepsy is common and troublesome among neurosurgical diseases.This study is designed to evaluate seizure control and degrees in intellectual outcome in children with refractory epilepsy after surgical treatment.Methods 27 children with refractory epilepsy were treated with individualized choices of epilepsy surgery.We used the Engel Epilepsy Surgery Outcome Scale to evaluate seizure control and the Wechsler Intelligence Scale for Children,fourth edition(WISC-IV),to test the children’s intellectual outcomes 7 days pre-operative and 3,6 and 12 months post-operative.We confirmed intellectual-outcome improvement after surgery by making comparisons of different aspects.Results We deemed 17 cases seizure free(Engel Ⅰ)and 5 cases to have suffered few attacks since surgery(Engel Ⅱ).In 3 cases,the frequency of seizures decreased by more than 90%(Engel Ⅲ).In the remaining 2 cases,the effects of surgery on seizure control were not obvious(Engel Ⅳ).All children completed the WISC-IV test post-operative intelligence quotient(IQ)increased by 2.00～12.00(6.70±2.45)分 points12 months post-surgery compared with the results of the pre-operative tests(P<0.001),and There is no significant difference in the cognitive effect between craniotomy and vagus nerve stimulation(P=0.066>0.05).Conclusion Individualized epilepsy surgery is safe and effective for children with refractory epilepsy.It can control or reduce the frequency of post-operative attacks as well as improve post-operative intellectual outcomes to different degrees.更多还原