Prognostic factors and outcome after different types of resection for temporal lobe epilepsy
Prognostic factors and outcome after different types of resection for temporal lobe epilepsy
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DOI：
10.3171/jns.2002.97.5.1131
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发表时间：
2002-11-01
影响因子：
4.1
通讯作者：
Elger, CE
中科院分区：
文献类型：
--
作者：
Clusmann, H;Schramm, J;Elger, CE
Object.目前尚不清楚不同的颞叶癫痫（TLE）切除策略是否会改变癫痫发作控制或神经心理学表现。对1989年至1997年期间接受手术治疗的321例TLE患者进行临床、电生理、神经影像学、神经心理学和手术因素的单因素和多因素分析，以确定预后的独立预测因素。直到1993年，大多数TLE患者接受了标准的前颞叶切除术（ATL）;从1993年开始，外科手术越来越局限于磁共振（MR）成像检测到的病变和假定的致痫灶：例如，杏仁核campectomy（AH）或病变切除术/皮质切除术开始更频繁地使用。227例患者被归类为无癫痫发作（70.7%），36例患者有罕见和非致残性癫痫发作（11.2%）;这些组被总结为癫痫发作控制良好（81.9%）。24名患者的改善率超过75% 34例无明显改善（10.6%）;这些组被总结为癫痫控制不满意在单因素分析中，下列术前因素与癫痫控制良好相关（p < 0.05）：脑电图检查单一且一致的偏侧病灶，癫痫发作频率低，无癫痫持续状态，一致的偏侧记忆缺陷，MR图像明显异常，疑似神经节细胞胶质瘤或胚胎发育不良性神经上皮肿瘤（DNT），MR图像上无发育不良。逐步逻辑回归揭示了一个包含五个因素的模型，这些因素可预测良好的癫痫控制（p < 0.1）：1）MR图像上的明显异常; 2）无癫痫持续状态; 3）MR图像证实的神经节细胞胶质瘤或DNT; 4）一致的偏侧记忆缺陷;以及5）MR图像上无发育异常。癫痫发作结局主要与诊断和临床因素有关。对于可比肿瘤进行的不同切除类型，未发现显著差异。神经心理学测试显示，与标准ATL相比，有限切除术后的术后结果更好，特别是在注意力水平、言语记忆和计算的总神经心理学表现方面。TLE的不同手术入路策略可获得同样良好的结局。癫痫发作的结果主要取决于诊断和临床因素，而神经心理学的结果是更有益的切除术后，仅限于致痫性病变和重点。
Object. It is unknown whether different resection strategies for temporal lobe epilepsy (TLE) produce alterations in seizure control or neuropsychological performance.Methods. A series of 321 patients who underwent surgery for TLE between 1989 and 1997 was submitted to a uniand multifactorial analysis of clinical, electrophysiological, neuroimaging, neuropsychological, and surgical factors to determine independent predictors of outcome. Until 1993, most patients with TLE underwent standard anterior temporal lobectomy (ATL); beginning in 1993, surgical procedures were increasingly restricted to lesions detected on magnetic resonance (MR) imaging and the presumed epileptogenic foci: for example, amygdalohippocampectomy (AH) or lesionectomy/corticectomy began to be used more often.The mean follow-up duration in this study was 38 months. Two hundred twenty-seven patients were classified as seizure free (70.7%), and 36 patients had rare and nondisabling seizures (11.2%); these groups were summarized as having good seizure control (81.9%). Twenty-four patients attained more than 75% improvement (7.5%), and no worthwhile improvement was seen in 34 cases (10.6%); these groups were summarized as having unsatisfactory seizure control (18.1%).On unifactorial analysis the following preoperative factors were associated with good seizure control (p < 0.05): single and concordant lateralizing focus on electroencephalography studies, low seizure frequency, absence of status epilepticus, concordant lateralizing memory deficit, clear abnormality on MR images, suspected ganglioglioma or dysembryoplastic neuroepithelial tumor (DNT), and absence of dysplasia on MR images. Stepwise logistic regression revealed a model containing five factors that were predictive for good seizure control (p < 0.1): 1) clear abnormality on MR images; 2) absence of status epilepticus; 3) MR imaging-confirmed ganglioglioma or DNT; 4) concordant lateralizing memory deficit; and 5) absence of dysplasia on MR images. Seizure outcome was mainly correlated with diagnosis and clinical factors. No significant differences were found regarding different resection types performed for comparable tumors. Neuropsychological testing revealed better postoperative results after limited resections compared with standard ATL, especially with regard to attention level, verbal memory, and calculated total neuropsychological performance.Conclusions. Different strategies for surgical approaches in TLE result in equally good outcomes. Seizure outcome is mainly dependent on the diagnosis and clinical factors, whereas the neuropsychological results are more beneficial after resections limited to an epileptogenic lesion and focus.