The Clinical Utility of Surgical Histopathology in Predicting Seizure Outcomes in Patients with Rasmussen Encephalitis Undergoing Hemispherectomy.
The Clinical Utility of Surgical Histopathology in Predicting Seizure Outcomes in Patients with Rasmussen Encephalitis Undergoing Hemispherectomy.
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DOI：
10.1016/j.wneu.2022.03.043
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发表时间：
2022-06
影响因子：
2
通讯作者：
Bingaman, William E.
中科院分区：
文献类型：
--
作者：
Bingaman, Justin R.;Sundar, Swetha J.;Hsieh, Jason K.;Lu, Elaine;Jehi, Lara;Wyllie, Elaine;Gupta, Ajay;Prayson, Richard;Bingaman, William E.
确定因Rasmussen癫痫而接受大脑半球切除术的患者的病理严重程度与癫痫结局之间的关系，并研究哪些临床因素与病理严重程度相关。在这项回顾性队列研究中，我们收集并审查了病理学和临床变量。我们使用恩格尔的分类确定癫痫发作的结果，并使用Pardo分期对病理进行分级。我们纳入了29名接受34例大脑半球切除术的独特患者进行分析。Pardo分期与癫痫发作结局之间无统计学显著相关性（p = 1）。癫痫持续时间的增加（β = 0.011，p = 0.02）和轻偏瘫持续时间的增加（β = 0.024，p = 0.01）与更严重的Pardo分期显著相关。相反，EPC的存在与Pardo分期呈负相关（β =-0.49，p = 0.04）。26例（89.75%）患者在末次随访时为Engel I级，包括我们队列中所有5例接受再次半球切除术的患者。与RE的进行性性质一致，更严重的病理与更长的癫痫持续时间和更长的轻偏瘫持续时间相关，而EPC的存在与不太严重的病理相关。该系列的结果表明，根据手术组织病理学评估的RE皮质受累程度与大脑半球切除术后的癫痫发作结局无关，后者似乎更依赖于手术技术/完全断开。
To determine the relationship between the severity of pathology and seizure outcomes in patients who underwent hemispherectomy for Rasmussen Encephalitis, and to investigate which clinical factors correlated with severity of pathology. In this retrospective cohort study, we collected and reviewed pathology and clinical variables. We ascertained seizure outcomes using Engel’s classification, and Pardo stages were used to grade pathology. We included 29 unique patients who underwent 34 hemispherectomy procedures for analysis. There was no statistically significant correlation between Pardo stage and seizure outcome (p = 1). Increasing duration of epilepsy (β = .011, p = .02) and duration of hemiparesis (β = .024, p = .01) were significantly associated with a more severe Pardo stage. In contrast, the presence of EPC had a negative relationship with Pardo stage (β = −.49, p = .04). 26 (89.75%) patients were Engel class I at last follow up, including all five patients who underwent redo hemispherectomy in our cohort. Consistent with the progressive nature of RE, more severe pathology was associated with a longer duration of epilepsy and longer duration of hemiparesis while the presence of EPC was associated with less severe pathology. Results from this series suggest the degree of cortical involvement with RE as assessed on surgical histopathology does not correlate with seizure outcome after hemispherectomy, which appears to be more dependent on surgical technique/complete disconnection.
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