PROGNOSTIC-SIGNIFICANCE OF ICTAL AND INTERICTAL EPILEPTIFORM ACTIVITY IN TEMPORAL-LOBE EPILEPSY
PROGNOSTIC-SIGNIFICANCE OF ICTAL AND INTERICTAL EPILEPTIFORM ACTIVITY IN TEMPORAL-LOBE EPILEPSY
复制标题
DOI：
10.1111/j.1528-1157.1994.tb01781.x
复制
发表时间：
1994-11-01
期刊：
影响因子：
5.6
通讯作者：
WIESTLER, OD
中科院分区：
文献类型：
--
作者：
HUFNAGEL, A;ELGER, CE;WIESTLER, OD
回顾分析59例颞叶癫痫(TLE)患者术前评估时长期硬膜下电极记录的长期皮层脑电(ECoG)，探讨发作间期癫痫样电位(IEP)的分布与癫痫发作起源(SO)的预后相关性及影响其定侧化的因素。在术前评估之后，所有患者都进行了标准化的三分之二前颞叶切除术，包括海马体次全切除术。结果表明：(A)只有单侧SO和IEP 100%定侧的患者癫痫发作效果良好(=89%无癫痫发作)，(B)双暂性SO患者不太可能从手术治疗中受益(=12.5%无癫痫发作)，(C)无论IEP的定侧程度如何，40-56%的单侧SO和双暂性IEP患者的癫痫无发作；(D)多维方差分析表明，SO的偏侧化、磁共振成像(MRI)可检测到的病变、海马硬化症、高热发作和小于或等于6岁的癫痫发作是表明癫痫发作取消的五个最重要的变量。ECoG记录的SO和IEP的联合分析可以预测术后癫痫控制在接近的范围内。
Long-term electrocorticograms (ECoG), recorded by chronically implanted subdural electrodes during preoperative evaluation of 59 patients with temporal lobe epilepsy (TLE) were analyzed retrospectively to assess the prognostic relevance of distribution of interictal epileptiform potentials (IEP) and seizure origin (SO) and to investigate factors affecting their lateralization. Subsequent to preoperative evaluation, a standardized two thirds anterotemporal lobectomy including subtotal hippocampectomy had been performed in all patients. The following results were obtained: (a) Only patients with 100% lateralization of SO and IEP had excellent seizure outcome (= 89% seizure-free); (b) patients with bitemporal SO were unlikely to benefit from surgical treatment (=12.5% seizure-free); (c) 40-56% patients with unilateral temporal SO and bitemporal IEP, became seizure-free irrespective of the degree of lateralization of IEP; and (d) multidimensional analysis of variance showed that lateralization of SO, presence of a magnetic resonance imaging (MRI)-detectable lesion, presence of hippocampal sclerosis, presence of febrile seizures and seizures at age less than or equal to 6 years are the five most important variables indicating abolition of seizures. Combined analysis of ECoG-recorded SO and IEP allows prediction of postoperative seizure control within close boundaries.