Outcome after surgery in patients with refractory temporal lobe epilepsy and normal MRI
Outcome after surgery in patients with refractory temporal lobe epilepsy and normal MRI
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DOI：
10.1053/seiz.2000.0423
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发表时间：
2000-09-01
影响因子：
3
通讯作者：
Ojemann, LM
中科院分区：
文献类型：
--
作者：
Holmes, MD;Born, DE;Ojemann, LM
我们的目的是确定手术治疗的高分辨率磁共振成像（MRI）正常的难治性颞叶癫痫患者的预后预测因素。我们确定了23例接受颞叶切除术的患者，术前MRI正常，包括表面线圈相控阵颞叶成像。所有患者术后随访至少2年。我们将结果分级为无癫痫、癫痫发作减少> 75%或癫痫发作减少75%，而13%（3/23）的癫痫发作减少> 75%。只有EEG结果在预测结果方面是有用的。当癫痫发作起源于基底颞区时，61%（11/18）的患者无癫痫发作，而当癫痫发作起源于中后颞区时，无癫痫发作（0/5）（P = 0.04）。在发作间期，如果所有癫痫样模式仅局限于一个基底颞区，这一发现总是与发作发作相关，则78%（7/9）的患者无癫痫，双侧或多灶性放电者，仅29%（4/14结论：对于MRI检查正常的颞叶癫痫患者，手术可能是一种合理的治疗方法。最好的结果发生在癫痫发作和发作间期癫痫样模式是唯一的一个基底颞区。当发作起源于中后颞区和发作间期放电为双颞或多灶分布时，最有可能发生不良结局。(C)2000年，中国国际贸易有限公司
Our purpose is to determine predictors of outcome in patients with refractory temporal lobe epilepsy and normal high resolution magnetic resonance imaging (MRI) who undergo surgical therapy. We identified 23 patients who underwent temporal lobectomy and had normal pre-operative MRI, including surface coil phased array temporal lobe imaging. All were followed at least 2 years after surgery. We graded outcome as seizure-free, >75% reduction in seizures, or 75% reduction in seizures, while 13% (3/23) had >75% reduction in seizures. Only the EEG findings were useful in predicting outcome. When ictal onsets arose from basal temporal regions, 61% (11/18) of patients were seizure-free, while none (0/5) were seizure-free when seizures arose from mid-posterior temporal regions (P = 0.04). Interictally, if all epileptiform patterns were localized exclusively to one basal-temporal region, a finding that invariably correlated with ictal onsets, 78% (7/9) of patients were seizure-free, while only 29% (4/14) were seizure-free if discharges were bilateral or multifocal (P = 0.04).We conclude that surgery may be a reasonable treatment for some patients with intractable temporal lobe seizures and normal MRI. The best outcomes occur when seizure onsets and interictal epileptiform patterns are exclusive to one basal-temporal region. Unfavorable outcomes are most likely to occur when ictal origins are from mid-posterior temporal regions and when interictal discharges are bitemporal or multifocal in distribution. (C) 2000 BEA Trading Ltd.