Surgical Diagnosis And Treatment Of Drug-resistant Epilepsy

Objective(s):To analyze the clinical efficacy and prognostic factors of different surgical methods for drug-resistant epilepsy.Methods:The clinical data of 41 neurosurgery patients from January 2014 to April 2020 in the First Affiliated Hospital of Kunming Medical University were retrospectively analyzed,including 25 males and 16 females,with a gender ratio of 25:16,the minimum age of 9 years old,the maximum age of 55 years old,and the average age of 30.49 years old.The history of epileptic seizures is as short as 1 year and as long as 34 years,with an average of 7.02 years.Under the condition of taking medicine,the attack frequency is at least about 2 times/month and at most about 17 times/month,with an average of 6.29 times/month.There were 2 cases of simple partial seizure(SPS),5 cases of complex partial seizure(CPS),9 cases of systemic seizure(SPS,GTCS)caused by simple partial seizure,23 cases of systemic seizure(CPS,GTCS)caused by complex partial seizure,and 2 cases of systemic rigidity(GTCS).Of 41 patients,35 received resection,4 received vagus nerve electrical stimulation and 2 received deep brain electrical stimulation.The postoperative curative effect was graded according to Engel's curative effect evaluation and analyzed to make a statistic on the influencing factors of MIE patients' prognosis.all the data were analyzed by SPSS26.0 statistical analysis software.the counting data and grade data were expressed by frequency(%):the measuring data were expressed by mean standard deviation(x s),the counting data were analyzed by X2 test,and Logistic model was used for multivariate analysis.the significance level was set to p<0.05,indicating the difference was statistically significant.Results:The follow-up time ranged from 1 month to 1 year after operation through telephone or outpatient follow-up.Follow-up of 41 patients in this group showed that 9 patients had no recurrence of epileptic symptoms,34 patients had remission of more than 50%compared with preoperative symptoms,and the number of seizures was less than 3 times per year.The remission rate of 7 patients was less than 50%.All postoperative patients were evaluated according to Engel's therapeutic effect classification:EngelI grade in 9 cases;Engel ? grade 15 cases;Engel ? grade 10 cases;Engel ? grade 7 cases.Chi-square test was used to evaluate the prognosis of 41 patients.Univariate analysis of sex,age,attack type,course of disease and attack frequency was carried out.The results were as follows:course of disease(X2=17.151,P=0.000);The attack frequency(X2=5.464,p=0.011)was statistically significant.Logistic regression analysis showed that it was only related to attack frequency.Conclusion(s):1.At present,surgery for drug-resistant epilepsy has become an extremely effective treatment method.If the drug treatments cannot control the seizure of epilepsy well and further increase drug treatment has little benefit,surgery for epilepsy should be carried out at an early stage;2.For different types of MIE,multidisciplinary cooperative image fusion and neuroelectrophysiological evaluation should be taken as the basis for individualized treatment at present;3.The sex,attack type and age of the patients have no statistical significance on the grading of the prognosis of the patients.The frequency of attack and duration of disease have statistical significance on the prognosis of patients.Logistic regression analysis showed that it was only related to attack frequency.