Phẫu thuật điều trị động kinh cục bộ kháng thuốc ở trẻ em tại Bệnh viện Nhi trung ương

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Tác giả: Lê Nam Thắng

Ngôn ngữ: Vie

Ký hiệu phân loại: 618.92 Pediatrics

Thông tin xuất bản: Nhi khoa 2023

Mô tả vật lý: 36-41

Bộ sưu tập: Metadata

ID: 399705

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Nghiên cứu hổi cứu được thực hiện trên 102 trẻ dưới 18 tuổi đã được phẫu thuật động kinh kháng thuốc tại Bệnh viện Nhi Trung ương từ năm 2010 đến 2021 và được theo dõi ít nhất 1 năm sau mổ. Bệnh nhân được tiến hành tiểu phẫu cắt bỏ tồn thương não gây động kinh theo đánh giá trước mổ, theo dõi điện não đổ video, chụp MRI và PET CT trong trường hợp cần thiết.Kết quả: Một số đặc điềm lâm sàng: Nam chiếm tỉ lệ 52,4%, nữ chiếm tỉ lệ 47,6%. Độ tuổi trung bình lúc phẫu thuật: 82,8 tháng. Thời gian trung bình từ khởi phát cơn đến trước phẫu thuật: 51,4 tháng. Độ tuồi trung bình khởi phát động kinh: 33,7 tháng. Đặc điểm động kinh: động kinh cục bộ đơn giản chiếm 33%, động kinh cục bộ phức hợp chiếm 8,3%, cơn cục bộ kết hợp toàn thể hóa thứ phát chiếm 33% và động kinh toàn thể chiếm 25%. Nghiên cứu cho thấy 58,3 % trường hợp có bất thường EEG cùng bên với tổn thương não, 8,3% trường hợp có bất thường đối bên và 33,3% có bất thường ở cả hai bên. về phương diện giải phẫu, động kinh thùy thái dương chiếm 58,3% động kinh ngoài thùy thái dương và động kinh liên quan nhiều thùy chiếm 41,6%. Về mô bệnh học, loạn sản vỏ não khu trú chiếm 41,6%, khối u giai đoạn sớm 25%, xơ cứng hồi hải mã 8,3%, hội chứng Rasmussen 16,6 % và không điển hình: 8,3 %. Giai đoạn theo dõi sau phẫu thuật, 87 bệnh nhân (83,3%) không còn co giật, theo phân loại Engel's class IA và IIA. Nhóm động kinh thùy thái dương có kết quả tốt nhất (71,4% trường hợp có Engel class IA và 28,6% Engel class IIA).Kết luận: Phẫu thuật động kinh là phương pháp hiệu quả trong điều trị động kinh cục bộ kháng thuốc., Tóm tắt tiếng anh, Hundred and two patients, younger than 18 years, operated on from 2010 to 2021 and followed-up for at least 1 year were identified at National Hospital of Pediatrics.Individualized microsurgical resections, aimed at removal of the epileptogenic lesion, were performed as indicated by the results of presurgical evaluations, which included video-electroencephalographic monitoring, specialized MR Imaging and PETCT scan when needed.Results: Some clinical characteristics: Male: 52,4%, Female: 47,6% Mean age at surgery: 82,8 months. Mean duration before surgery: 51,4 months. Mean age at seizure onset: 33,7 months. Seizure semeiology: simple partial seizure: 33%, complex partial seizure: 8.3%, partial seizure with 2nd generalization: 33% and generalized seizure: 25%. EEG abnormalities were ipsilateral to the epileptogenic lesion in 58,3 % of cases, contralateral in 8,3% and bilateral in 33,3 %. Anatomically, temporal lobe involvement accounted for 58,3% of cases, extra-temporal lobe and multi-lobar involvements accounted for the remaining 41.6%. Histopathologically, focal cortical dysplasia: 41,6%, low-grade tumors: 25%, hippocampal sclerosis: 8,3%, Rasmussen syndrome 16,6 % and unremarkable: 8,3 %. At post-surgical follow-up, 87 patients (83,3%) were seize-free, in Engel's class IA & 11 A.Temporal lobe group had the best outcome (with 71,4 % of cases had Engel class IA and 28,6% had Engel class 11 A).Conclusion: Drug-resistant localization-related epilepsies in children could be cured successfully by resective surgery in the majority of cases.

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