Abstract:

Abstracts： Objective To study the diagnosis and treatment by the model of multidisciplinary team treatment for intractable epilepsy in children. Methods We retrospectively reviewed the clinical data of 43 pediatric cases of intractable epilepsy in our institution from 2012 to 2014，aged from 8 months to 12 years， with an average age of 5 years. Results Totally 29 cases could be found the related factors of epilepsy in the past history， including prenatal and perinatal factors in 9 cases， 8 cases of traumatic intracranial hemorrhage， 3 cases of spontaneous intracranial hemorrhage， 2 cases of disorders of cortical development， 2 cases of vascular malformation， 2 cases of tuberous sclerosis，1 cases of Sturge-Weber syndrome， 1 cases of infection， and intraventricular tumor after operation in 1 case. Five cases underwent surgery and the follow-up was from 3 to 18 months （mean 10 months）， 4 of 5 （80%） achieved seizure freedom （Engel Ⅰ）， and 1 （20%） demonstrated worthwhile improvement （Engel Ⅲ）. Conclusions Multidisciplinary team treatment is an effective model in diagnosis and treatment of childhood intractable epilepsy．Surgical intervention in children with intractable seizures can yield favorable seizure outcome.

Key words: intractable epilepsy, multidisciplinary team, diagnosis, treatment, operation, children

摘要：

目的 探讨儿童难治性癫痫的多学科协作诊断及治疗模式。方法 回顾分析2012年3月至2014年2月上海儿童医学中心儿童癫痫诊治中心收治的43例难治性癫痫患儿的诊断、治疗及随访情况。对难治性癫痫多学科协作诊断治疗模式、术前评估内容及手术指征选择进行分析。结果 43例难治性癫痫患儿均进行多学科的协作诊治，其中男性25例，女性18例；年龄8个月至12岁，平均5岁。29例病例找到病因，包括产前和围生期因素9例，外伤性颅内出血8例，自发性颅内出血3例，皮质发育障碍2例，脑血管畸形2例，结节性硬化2例，Sturge-Weber综合征1例，感染性因素1例，脑室肿瘤术后1例。经多学科讨论建议其中29例继续药物治疗，12例建议采取手术方案，2例建议进行生酮饮食。最终5例病例同意并施行手术，术后随访3~18月，4例（4/5）预后分级为Engel癫痫疗效分级Ⅰ级，1例（20%）预后分级为Ⅲ级。结论 多学科协作模式在儿童难治性癫痫的诊断和治疗中可以发挥积极的作用，为难治性癫痫患儿选择合适的治疗方案提供帮助，经过综合评估后采取的手术治疗能够有效地提高难治性癫痫的治疗效果，生酮饮食治疗目前患者的接受度还不够，有待进一步宣传推广。

关键词: 难治性癫痫, 多学科协作, 诊断, 治疗, 手术, 儿童