癫痫手术可提高长期生活质量

华盛顿——据美国癫痫学会(AES)年会上报告的一项调查结果，大部分接受切除性癫痫手术的成人患者长期结局较好，无论是从癫痫发作频率来看，还是从社会心理因素的角度判断。报告者为底特律亨利•福特综合性癫痫项目中的Spanaki-Varelas医生。

在253名回应者中，有82名（32%）在术后平均10.6年中无癫痫发作，189名（75%）结局较好（定义为Engel-Ⅰ级或Ⅱ级手术结局）。逾半数（51%）患者术后驾车，而术前仅35%的患者驾车。回应者当前与术前相比全天工作的几率下降（23% vs. 42%），但85%的接受颞叶切除术的患者与接受颞叶外切除术的患者相比，就业率提高（45% vs. 26%）。同时，与术前相比，术后服用抗抑郁药的患者人数增加（30% vs. 22%）在结局较好的患者中，65%术后驾车（而结局欠佳的患者中有11%），28%目前在职（结局欠佳者中有8%），仅24%的患者在服用抗抑郁药（结局欠佳者中有47%）。

或许最值得关注的是，无论手术部位在哪，92%的回应者都认为癫痫手术是值得做的，其中包括98%的结局较好者和74%的结局欠佳者。即便在结局欠佳的患者中，癫痫发作频率也常常减少，患者感到满意。该结果强调了生活质量的重要性——手术能够提高生活质量，研究者表示在发病后应及早考虑将患者转诊做手术。

回应者参与调查时的平均年龄为46岁，确诊为癫痫时的平均年龄接近16岁，手术时的平均年龄为35岁，均于1993~2011年间在亨利•福特综合性癫痫项目中进行手术。研究者对患者的病历进行了前瞻性回顾，患者是在2012年5月~2013年1月间接受了调查。有接近1/3（30%）的回应者进行了至少20年的随访。

令人担忧的是，对许多患者而言，这项具有改变生活潜能的手术被推迟了将近20年，推迟手术的部分原因是常识错误，即患者尝试服用的药物越多，结局就会越好。这种误解推迟了对手术干预的评估。另外，调查还显示许多医生因为对手术的风险和收益缺乏了解，没有足够的信心，不会将患者转诊做手术评估。

上述结果凸显了提高患者教育的必要性，而患者教育可能会提高自行转诊率。

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By: SHARON WORCESTER, Clinical Neurology News Digital Network

WASHINGTON – Resective epilepsy surgery yielded favorable long-term outcomes with respect to both seizure frequency and psychosocial factors in the majority of adult patients who participated in a recent survey.

Of 253 respondents, 82 (32%) were free of seizures at a mean of 10.6 years after surgery, and 189 (75%) had a favorable outcome, defined as Engel’s Class I or II surgery outcome, Dr. Marianna V. Spanaki-Varelas reported in a poster at the annual meeting of the American Epilepsy Society.

Overall, more than half (51%) of the patients were driving after surgery, compared with 35% before surgery, Dr. Spanaki-Varelas of Henry Ford Comprehensive Epilepsy Program, Detroit.

Respondents were less likely currently to be working full time when surveyed vs. prior to surgery (23% vs. 42%), but employment was greater in the 85% of patients who underwent temporal vs. extratemporal resection (45% vs. 26%).

Also, more patients were using antidepressants after surgery, compared with before surgery (30% vs. 22%).

Among the patients with favorable outcomes, 65% were driving after surgery (compared with 11% of those without a favorable outcome), 28% were currently employed, (compared with 8% of those without favorable outcomes), and only 24% were taking antidepressants (compared with 47% of those without a favorable outcome).

Perhaps most notable was that regardless of surgery site, 92% of respondents considered epilepsy surgery worthwhile, including 98% of those with a favorable outcome and 74% of those without a favorable outcome.

Even in patients without a favorable outcome, seizure frequency was often reduced and patients were satisfied, she explained, noting that the findings reinforce the importance of quality of life – and the ability of surgery to enhance quality of life, and they suggest that referral for surgery should be considered earlier in the course of treatment.

The respondents had a mean age of 46 years at the time of the survey, a mean age of nearly 16 years at epilepsy diagnosis, and a mean age of 35 years at the time of surgery, which took place at the Henry Ford Epilepsy Program between 1993 and 2011. Patient records were retrospectively reviewed, and the patients were surveyed between May 2012 and January 2013.

Nearly a third (30%) had follow-up of at least 20 years, Dr. Spanaki-Varelas noted.

It is concerning that potentially life-changing surgery is being delayed nearly 20 years for many patients, she said, noting that part of the reason for delay is the common misconception that the more medications a patient tries, the better their outcome will be. This delays evaluations for surgical intervention. Also, surveys suggest that many physicians don’t refer patients for surgical evaluation because they don’t feel confident regarding their knowledge of the risks and benefits of surgery.

These findings underscore the need for better patient education, which may improve self-referral rates, she said.