Predictive Factors of Surgical Outcome in Frontal Lobe Epilepsy Explored with Stereoelectroencephalography
Predictive Factors of Surgical Outcome in Frontal Lobe Epilepsy Explored with Stereoelectroencephalography
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DOI：
10.1093/neuros/nyx342
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发表时间：
2018-08-01
期刊：
影响因子：
4.8
通讯作者：
Bartolomei, Fabrice
中科院分区：
文献类型：
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作者：
Bonini, Francesca;McGonigal, Aileen;Bartolomei, Fabrice
背景技术背景：切除手术是一种行之有效的治疗药物耐药性额叶癫痫（FLE），但癫痫发作的结果和预后指标的特点和不同的study.Objective：研究长期癫痫发作的结果，并确定预后factors.METHODS：我们回顾性分析了42例FLE患者进行了手术切除，大多是由侵入性记录与立体脑电图（SEEG）。术后结果长达10年的随访和预后指标进行了分析，使用Kaplan-Meier分析和多变量和条件推理proceeding.RESULTS：在最后一次随访时，57.1%的患者无复发。6个月时无癫痫发作的估计概率为67%（95%置信区间[CI]：54-83），1年时为59%（95% CI：46-76），2年时为53%（95% CI：40-71），5年时为46%（95% CI：32-66）。大多数复发（83%）发生在前12个月内。多因素分析显示，SEEG定义的致痫区（EZ）切除的完整性是癫痫发作结局的主要预测因素。根据条件推理树，在EZ完全切除的患者中，局灶性皮质发育不良是病因，局灶性EZ是阳性预后指标。阳性与阴性磁共振imaging.CONCLUSION：耐药FLE的手术切除术可以是一种成功的治疗方法，即使在没有神经放射学可见病变的情况下。SEEG在非病灶性和病灶性FLE病例中可能非常有用，因为SEEG定义的EZ完全切除与更好的预后相关。
BACKGROUND: Resective surgery is a well-established treatment for pharmacoresistant frontal lobe epilepsy (FLE), but seizure outcome and prognostic indicators are poorly characterized and vary between studies.OBJECTIVE: To study long-term seizure outcome and identify prognostic factors.METHODS: We retrospectively analyzed 42 FLE patients having undergone surgical resection, mostly preceded by invasive recordings with stereoelectroencephalography (SEEG). Postsurgical outcome up to 10-yr follow-up and prognostic indicators were analyzed using Kaplan-Meier analysis and multivariate and conditional inference procedures.RESULTS: At the time of last follow-up, 57.1% of patients were seizure-free. The estimated chance of seizure freedom was 67% (95% confidence interval [CI]: 54-83) at 6 mo, 59% (95% CI: 46-76) at 1 yr, 53% (95% CI: 40-71) at 2 yr, and 46% (95% CI: 32-66) at 5 yr. Most relapses (83%) occurred within the first 12 mo. Multivariate analysis showed that completeness of resection of the epileptogenic zone (EZ) as defined by SEEG was the main predictor of seizure outcome. According to conditional inference trees, in patients with complete resection of the EZ, focal cortical dysplasia as etiology and focal EZ were positive prognostic indicators. No difference in outcome was found in patients with positive vs negative magnetic resonance imaging.CONCLUSION: Surgical resection in drug-resistant FLE can be a successful therapeutic approach, even in the absence of neuroradiologically visible lesions. SEEG may be highly useful in both nonlesional and lesional FLE cases, because complete resection of the EZ as defined by SEEG is associated with better prognosis.