Predictors of efficacy after stereotactic radiosurgery for medial temporal lobe epilepsy
Predictors of efficacy after stereotactic radiosurgery for medial temporal lobe epilepsy
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DOI：
10.1212/wnl.0b013e3181c9185d
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发表时间：
2010-01-12
期刊：
影响因子：
9.9
通讯作者：
Barbaro, N. M.
中科院分区：
文献类型：
--
作者：
Chang, E. F.;Quigg, M.;Barbaro, N. M.
背景：立体定向放射外科（RS）是治疗难治性内侧颞叶癫痫（MTLE）的一种很有前途的方法。然而，其疗效的基础是不好理解。方法：30例MTLE患者前瞻性随机接受20或24戈伊50%等剂量RS集中在杏仁核，2厘米的前海马，海马旁回。治疗后MRI定量评价异常T2高信号和对比增强，质量效应，定性光谱和扩散变化。MRI结果与辐射剂量和癫痫缓解（恩格尔Ib或更好的结果）的潜在关联进行了分析。结果：尽管高度标准化的剂量靶向，RS产生可变的MRI改变。在多次连续成像的患者中，血管源性水肿的出现发生在RS后约9-12个月，并与癫痫发作缓解相关。扩散和光谱检测到的变化是一致的颞叶辐射损伤的机制介导的局部血管损伤和神经元的损失。放射学反应峰值时的这些早期改变的程度具有剂量依赖性，并预测在第三年随访时癫痫发作的长期缓解。影像学的变化与neurocognitive impairments.Conclusions：颞叶立体定向放射外科手术导致显着的癫痫发作减少延迟的方式似乎是良好的相关性与神经影像学上观察到的结构和生化改变。早期发现的变化可能提供预后信息，指导管理。神经病学（R）2010;74：165-172
Background: Stereotactic radiosurgery (RS) is a promising treatment for intractable medial temporal lobe epilepsy (MTLE). However, the basis of its efficacy is not well understood.Methods: Thirty patients with MTLE were prospectively randomized to receive 20 or 24 Gy 50% isodose RS centered at the amygdala, 2 cm of the anterior hippocampus, and the parahippocampal gyrus. Posttreatment MRI was evaluated quantitatively for abnormal T2 hyperintensity and contrast enhancement, mass effect, and qualitatively for spectroscopic and diffusion changes. MRI findings were analyzed for potential association with radiation dose and seizure remission (Engel Ib or better outcome).Results: Despite highly standardized dose targeting, RS produced variable MRI alterations. In patients with multiple serial imaging, the appearance of vasogenic edema occurred approximately 9-12 months after RS and correlated with onset of seizure remission. Diffusion and spectroscopy-detected alterations were consistent with a mechanism of temporal lobe radiation injury mediated by local vascular insult and neuronal loss. The degree of these early alterations at the peak of radiographic response was dose-dependent and predicted long-term seizure remission in the third year of follow-up. Radiographic changes were not associated with neurocognitive impairments.Conclusions: Temporal lobe stereotactic radiosurgery resulted in significant seizure reduction in a delayed fashion which appeared to be well-correlated with structural and biochemical alterations observed on neuroimaging. Early detected changes may offer prognostic information for guiding management. Neurology (R) 2010;74:165-172