胶质瘤患者肿瘤相关性癫痫发作的术后结果

K. Chizhova, D. A. Gulyaev, I. I. Korepanov, I. Belov, I. А. Kurnosov, V. Chirkin, K. Sulin, I. V. Chistova, I. Yakovenko
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摘要

背景。50-90%的低级别胶质瘤患者和20-60%的胶质母细胞瘤患者会出现癫痫发作。肿瘤相关性癫痫是影响这类患者生活质量的主要标准之一。研究手术切除后肿瘤相关性癫痫形成和持续存在的风险因素,有助于为这类患者提供最适当的护理,使其免于癫痫发作并延长无复发期。研究胶质瘤患者手术治疗前、术后偏远病例癫痫发作的特征。经组织学证实的胶质瘤患者(n = 184)接受了全切或非全切显微神经切除术。手术后 1 个月对切除的根治性进行评估。观察期为 5 年。所有患者被分为 4 组。第一组包括102名(55.42%)术后癫痫发作缓解的患者;第二组包括2名术后首次癫痫发作的患者--1名(0.54%)在术后早期,1名(0.54%)在术后晚期;第三组--23名(12.5%)术前术后均有癫痫发作的患者;第四组--57名(31%)无癫痫发作的患者。79(77.4%)名癫痫发作有所缓解的患者接受了全切除手术。癫痫发作过程的动态变化并不取决于其最初的性质和频率。根据RANO标准,24例(70.6%)新发作患者有肿瘤复发,其中15例(62.5%)患者的发作复发早于肿瘤复发。结论:肿瘤相关性癫痫最常见于低级别胶质瘤。通过控制癫痫发作,全切除术可以延长患者的预期寿命并改善其生活质量。对这类患者进行辅助治疗的效果直接关系到肿瘤相关性癫痫的治疗效果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Postoperative outcomes of tumor-associated epileptic seizures in glioma patients
Background. Epileptic seizures occur in 50–90 % of patients with low‑grade glioma and in 20–60 % of patients with glioblastoma. The presence of tumor‑associated epilepsy is one of the leading criteria affecting the quality of life of this cohort of patients. The study of risk factors for the formation and persistence of tumor‑associated epilepsy after surgical resection can contribute to the most adequate care for such patients in terms of freedom from seizures and the duration of the relapse‑free period.Aim. To study the features of epileptic seizures before surgical treatment, in remote cases of the postoperative period in patients with glioma.Materials and methods. Patients (n = 184) with histologically verified gliomas underwent total or non‑total microsur‑ gical removal of the tumor. The radicality of resection was assessed 1 month after the operation. The observation was carried out for 5 years.Results. All patients were divided into 4 groups. The 1st group consisted of 102 (55.42 %) patients whose seizures regressed after surgery; the 2nd group included 2 patients with the first seizures after surgery – 1 (0.54 %) in the early and 1 (0.54 %) in the late postoperative period; the 3rd group – 23 (12.5 %) patients with seizures both before and after surgery; the 4th group – 57 (31 %) patients without seizures. Total resection was performed significantly more often in the group with regressed seizures – in 79 (77.4 %) patients. The dynamics of the course of seizures did not depend on their initial nature and frequency. Twenty four (70,6 %) patients with new seizures had tumor recurrence, of which 15 (62.5 %) patients had seizure recurrence earlier than tumor recurrence based on RANO criteria.Conclusion. Tumor‑associated epilepsy is most common in low‑grade gliomas. Total resection allows to increase life expectancy and improve its quality by controlling seizures. The effectiveness of adjuvant treatment of this cohort of patients is directly related to the results of treatment of tumor‑associated epilepsy.
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