儿科手术后的长期智力和发育结果:系统性审查和元分析
Ilona Stefanos-Yakoub1, Kevin Wingeier1,2, Ulrike Held3
1Department of Neuropediatrics, University Children's Hospital Zurich, Zurich, Switzerland.
Epilepsia
|November 30, 2023
概括
儿科手术稳定了认知发展,智商 (IQ/DQ) 长期保持稳定. 优化智商/智商提升与停止抗发作药物 (ASM) 在实现无发作后有关.
科学领域:
- 儿科神经学 儿科神经学
- 发育神经科学的发展神经科学.
- 手术的结果 手术结果
背景情况:
- 儿科手术旨在实现发作自由和改善认知发展.
- 手术后的长期智力和发育结果需要进一步阐明.
- 儿童的焦点性病症对认知轨迹提出了独特的挑战.
研究的目的:
- 系统地审查和分析儿童手术后的长期智力和发育结果.
- 为了确定手术后智力或发育系数 (IQ/DQ) 的变化.
- 为了确定影响手术后认知轨迹的因素.
主要方法:
- 15项研究的系统综述和随机效应元分析.
- 纳入标准:年龄在18岁以下的儿童患有焦点病变性,手术前和手术后的IQ/DQ评估>2年手术后.
- 进行元回归分析,以评估智商/智商度的决定因素的变化.
主要成果:
- 整体平均手术前IQ/DQ为60,手术后IQ/DQ为61,非显著变化为+0.94.
- 在手术前IQ/DQ≥70的儿童表现出更高收益的趋势.
- 手术后停止抗发作药物 (ASM) 与更高的认知收益相关 (p=0.041).
结论:
- 儿童手术通常会导致长期稳定的智力和发育功能.
- 实现发作自由至关重要,但在手术后停止ASM可能会进一步优化认知轨迹.
- 个性化手术后管理,包括ASM退出,可以提高发育结果.
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