Neurology：癫痫患者手术时机与病情严重度和非临床因素相关
2013-04-19 高晓方 译 医学论坛网
美国学者的一项研究表明。在癫痫患儿中，至手术时间较短与病情严重度和保险类型相关，种族及转诊前MRI检查亦与之相关。论文于2013年3月6日在线发表于《神经病学》（Neurology）。 此项研究共纳入430例接受癫痫手术的18岁以下患儿。利用多变量Cox比例风险模型评估临床严重度、转诊前脑MRI和社会人口学特征与至手术时间的特定相关性。 结果显示，至手术时间较短与活动性（危险比[H
美国学者的一项研究表明。在癫痫患儿中，至手术时间较短与病情严重度和保险类型相关，种族及转诊前MRI检查亦与之相关。论文于2013年3月6日在线发表于《神经病学》（Neurology）。
此项研究共纳入430例接受癫痫手术的18岁以下患儿。利用多变量Cox比例风险模型评估临床严重度、转诊前脑MRI和社会人口学特征与至手术时间的特定相关性。
结果显示，至手术时间较短与活动性（危险比[HR] 5.67）或成功治疗（HR 2.20）的婴儿痉挛、每日或更多的癫痫发作（HR 2.09）、无论影像学结果如何的转诊前MRI检查（HR 1.95）、个人保险（HR 1.54）以及西班牙裔（HR 1.38）具有相关性。种族及保险状况与至手术时间最短具有相互作用。
与癫痫相关的拓展阅读：
- Neurology：外部三叉神经刺激对耐药性癫痫或有效
- Neurology:癫痫发作独立预测卒中静脉溶栓患者远期预后
- Lancet Neurol：胎儿期暴露于抗癫痫药，影响6岁时认知功能
- JAMA Neurol：院内癫痫发作死亡率较高
- 年轻癫痫患者易出现社交问题 更多信息请点击：有关癫痫更多资讯
Time to pediatric epilepsy surgery is related to disease severity and nonclinical factors
OBJECTIVE
To identify clinical and nonclinical factors associated with time from epilepsy onset to surgical evaluation and treatment among a cohort of children having epilepsy surgery.
METHODS
Data were abstracted from records of 430 children (younger than 18 years) who had epilepsy neurosurgery at the University of California, Los Angeles from 1986 to 2010. Multivariable Cox proportional hazards models were used to analyze unique associations of clinical severity, pre-referral brain MRI, and sociodemographic characteristics with time to surgery.
RESULTS
Shorter time to surgery was associated with active (hazard ratio [HR] 5.67, 95% confidence interval [CI] 3.74-8.70) and successfully treated infantile spasms (HR 2.20, 95% CI 1.63-2.96); daily or more seizures (HR 2.09, 95% CI 1.58-2.76); MRI before referral regardless of imaging findings (HR 1.95, 95% CI 1.47-2.58); private insurance (HR 1.54, 95% CI 1.14-2.09); and Hispanic ethnicity (HR 1.38, 95% CI 1.01-1.87). There were race/ethnicity by insurance interactions (log-rank p = 0.049) with shortest time to surgery for Hispanic children with private insurance.
CONCLUSIONS
Shorter intervals to surgical treatment were associated with greater epilepsy severity and insurance type, consistent with existing literature. However, associations of shorter times to treatment with having a brain MRI before referral and Hispanic ethnicity were unexpected and warrant further investigation. More knowledgeable referring providers and parents with greater help-seeking capability may explain obtaining an MRI before referral. Shorter intervals to surgery among Hispanic children may relate to the same factors yielding an increased volume of Hispanic children receiving surgery at the University of California, Los Angeles since 2000.
作者：高晓方 译
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#严重度#
0
#临床因素#
40
#癫痫患者#
32
#手术时机#
55
#病情#
40