Long-term outcomes after nonlesional extratemporal lobe epilepsy surgery.
Long-term outcomes after nonlesional extratemporal lobe epilepsy surgery.
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DOI：
10.1001/jamaneurol.2013.209
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发表时间：
2013-08
期刊：
影响因子：
29
通讯作者：
Worrell, Gregory A.
中科院分区：
文献类型：
--
作者：
Noe, Katherine;Sulc, Vlastimil;Wong-Kisiel, Lily;Wirrell, Elaine;Van Gompel, Jamie J.;Wetjen, Nicholas;Britton, Jeffrey;So, Elson;Cascino, Gregory D.;Marsh, W. Richard;Meyer, Fredric;Horinek, Daniel;Giannini, Caterina;Watson, Robert;Brinkmann, Benjamin H.;Stead, Matt;Worrell, Gregory A.
通过使用磁共振成像（MRI）检测到的局灶性病变是癫痫手术的有利预后发现。MRI正常的颞叶外癫痫患者预后较差。大多数研究调查接受（非病灶）颞外癫痫手术的MRI结果正常的患者的结局仅限于高度选择的患者组，随访时间有限。评价一组耐药性非病灶性颞外癫痫患者的无创诊断测试结果及其与优良手术结局（使用Engel I-IIA级手术结局定义）的相关性。回顾性研究。马约诊所，罗切斯特，明尼苏达州。从1997年到2002年，我们确定了85例具有正常MRI表现的耐药性颞叶外癫痫患者。根据多学科癫痫手术会议的标准化术前评估和审查，选择其中一些患者进行颅内脑电图（EEG）监测和癫痫手术。非病灶性颞叶外癫痫手术。在至少随访1年（平均随访9年）的患者中检查了非侵入性诊断测试的结果和可能与良好手术结局相关的临床变量。基于无创诊断测试结果，85例患者中的47例（55%）可能存在癫痫发作起源的明确假设，这47例患者中的31例（66%）进行了颅内EEG监测。对于这31例接受长期颅内EEG检查的患者中的24例（77%），发现了癫痫病灶并进行了手术切除。在这24例患者中，9例（38%）在切除性癫痫手术后结局良好。所有手术结局良好的患者均接受了至少10年的随访。单因素分析显示，头皮EEG上的局部发作间期癫痫样放电与良好的手术结果相关。头皮脑电图是最有用的测试，以确定患者与正常的MRI结果和颞叶外癫痫谁可能有良好的结果后癫痫手术。将结果分析从切除手术组扩展到整个接受评估的患者组，进一步突出了这些患者带来的挑战。虽然24例接受切除手术的患者中有9例（38%）获得了良好的结局，但31例接受颅内EEG的患者中只有9例（29%）和85例非病灶性颞叶外癫痫患者中只有9例（11%）获得了长期良好结局。
A focal lesion detected by use of magnetic resonance imaging (MRI) is a favorable prognostic finding for epilepsy surgery. Patients with normal MRI findings and extratemporal lobe epilepsy have less favorable outcomes. Most studies investigating the outcomes of patients with normal MRI findings who underwent (nonlesional) extratemporal epilepsy surgery are confined to a highly select group of patients with limited follow-up. To evaluate noninvasive diagnostic test results and their association with excellent surgical outcomes (defined using Engel classes I–IIA of surgical outcomes) in a group of patients with medically resistant nonlesional extratemporal epilepsy. A retrospective study. Mayo Clinic, Rochester, Minnesota. From 1997 through 2002, we identified 85 patients with medically resistant extratemporal lobe epilepsy who had normal MRI findings. Based on a standardized presurgical evaluation and review at a multi-disciplinary epilepsy surgery conference, some of these patients were selected for intracranial electroencephalographic (EEG) monitoring and epilepsy surgery. Nonlesional extratemporal lobe epilepsy surgery. The results of non-invasive diagnostic tests and the clinical variables potentially associated with excellent surgical outcome were examined in patients with a minimum follow-up of 1 year (mean follow-up, 9 years). Based on the noninvasive diagnostic test results, a clear hypothesis for seizure origin was possible for 47 of the 85 patients (55%), and 31 of these 47 patients (66%) proceeded to intracranial EEG monitoring. For 24 of these 31 patients undergoing long-term intracranial EEG (77%), a seizure focus was identified and surgically resected. Of these 24 patients, 9 (38%) had an excellent outcome after resective epilepsy surgery. All patients with an excellent surgical outcome had at least 10 years of follow-up. Univariate analysis showed that localized interictal epileptiform discharges on scalp EEGs were associated with an excellent surgical outcome. Scalp EEG was the most useful test for identifying patients with normal MRI findings and extratemporal lobe epilepsy who were likely to have excellent outcomes after epilepsy surgery. Extending outcome analysis beyond the resective surgery group to the entire group of patients who were evaluated further highlights the challenge that these patients pose. Although 9 of 24 patients undergoing resective surgery (38%) had excellent outcomes, only 9 of 31 patients undergoing intracranial EEG (29%) and only 9 of 85 patient with nonlesional extratemporal lobe epilepsy (11%) had long-term excellent outcomes.
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影响因子：
11.2
作者：
Callaghan, Brian C.;Anand, Kishlay;French, Jacqueline A.
通讯作者：
French, Jacqueline A.
影响因子：
5.6
作者：
CASCINO, GD;KELLY, PJ;TRENERRY, MR
通讯作者：
TRENERRY, MR
影响因子：
3
作者：
Holmes, MD;Born, DE;Ojemann, LM
通讯作者：
Ojemann, LM
影响因子：
14.5
作者：
Jeha, Lara E.;Najm, Imad;Luders, Hans
通讯作者：
Luders, Hans
影响因子：
9.9
作者：
O'Brien, TJ;So, EL;Meyer, FB
通讯作者：
Meyer, FB