Surgical outcome and prognostic factors of frontal lobe epilepsy surgery
Surgical outcome and prognostic factors of frontal lobe epilepsy surgery
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DOI：
10.1093/brain/awl364
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发表时间：
2007-02-01
期刊：
影响因子：
14.5
通讯作者：
Luders, Hans
中科院分区：
文献类型：
--
作者：
Jeha, Lara E.;Najm, Imad;Luders, Hans
额叶癫痫（FLE）手术是第二大最常见的手术进行治疗药物抵抗性癫痫。然而，对额叶切除术后的长期癫痫发作结果知之甚少。本研究的目的是调查纵向结果的趋势，并确定使用现代诊断技术调查的FLE患者队列中的潜在预后指标。我们回顾了1995年至2003年间接受额叶切除术的70例患者（平均随访4.1±3年）。采用生存分析和Cox比例风险模型进行多变量回归分析。一个有利的结果被定义为完全无癫痫发作，允许先兆和癫痫发作限制在术后第一周。术后1年完全癫痫恢复的估计概率为55.7%[95%可信区间(CI) = 50-62]， 3年为45.1% (95% CI = 39-51)， 5年为30.1% （95% CI = 21-39）。80%的癫痫复发发生在术后6个月内。晚期缓解和复发发生，但罕见。经多因素分析，以下变量作为癫痫发作复发的独立预测因子仍具有重要意义：MRI阴性皮质发育畸形作为疾病病因[危险比(RR) = 2.22, 95% CI = 1.40-3.47]，任何额外MRI异常（RR = 1.75, 95% CI = 1.12-2.69），全局性/非局限性脑电图（RR = 1.83, 95% CI = 1.15-2.87），术后急性癫痫发作（RR = 2.17, 95% CI = 1.50-3.14）和手术切除不全（RR = 2.56, 95% CI = 1.66-4.05）（对数似然比检验p值< 0.0001）。在预后良好的患者中，超过一半的患者在3年时无癫痫发作，高达40%的患者在5年时无癫痫发作，而在预后不良的患者中，这一比例< 15%。这些数据强调了适当选择潜在手术候选人的重要性。
Frontal lobe epilepsy (FLE) surgery is the second most common surgery performed to treat pharmacoresistant epilepsy. Yet, little is known about long-term seizure outcome following frontal lobectomy. The aim of this study is to investigate the trends in longitudinal outcome and identify potential prognostic indicators in a cohort of FLE patients investigated using modern diagnostic techniques. We reviewed 70 patients who underwent a frontal lobectomy between 1995 and 2003 ( mean follow-up 4.1 +/- 3 years). Data were analysed using survival analysis and multivariate regression with Cox proportional hazard models. A favourable outcome was defined as complete seizure-freedom, allowing for auras and seizures restricted to the first post-operative week. The estimated probability of complete seizure-freedom was 55.7% [95% confidence interval (CI) = 50-62] at 1 postoperative year, 45.1% ( 95% CI = 39-51) at 3 years, and 30.1% ( 95% CI = 21-39) at 5 years. Eighty per cent of seizure recurrences occurred within the first 6 post-operative months. Late remissions and relapses occurred, but were rare. After multivariate analysis, the following variables retained their significance as independent predictors of seizure recurrence: MRI-negative malformation of cortical development as disease aetiology [ risk ratio (RR) = 2.22, 95% CI = 1.40-3.47], any extrafrontal MRI abnormality ( RR = 1.75, 95% CI = 1.12-2.69), generalized/non-localized ictal EEG patterns (RR = 1.83, 95% CI = 1.15-2.87), occurrence of acute postoperative seizures (RR = 2.17, 95% CI = 1.50-3.14) and incomplete surgical resection (RR = 2.56, 95% CI = 1.66-4.05) ( log likelihood-ratio test P-value < 0.0001). More than half of patients in favourable prognostic categories were seizure-free at 3 years, and up to 40% were seizure-free at 5 years, compared to < 15% in those with unfavourable outcome predictors. These data underscore the importance of appropriate selection of potential surgical candidates.