Surgical Outcomes in Patients With Extratemporal Epilepsy and Subtle or Normal Magnetic Resonance Imaging Findings
Surgical Outcomes in Patients With Extratemporal Epilepsy and Subtle or Normal Magnetic Resonance Imaging Findings
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DOI：
10.1227/01.neu.0000429839.76460.b7
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发表时间：
2013-07-01
期刊：
影响因子：
4.8
通讯作者：
Bingaman, William
中科院分区：
文献类型：
--
作者：
See, Siew-Ju;Jehi, Lara E.;Bingaman, William
背景：手术是难治性癫痫患者的重要治疗选择。颞外癫痫灶和无病变磁共振成像（MRI）的结合通常被认为预示着不良结局。目的：研究MRI显示无病变的患者接受颞外切除术的结局并分析潜在的预后预测因素。方法：临床、术前评估、侵入性监测，对最初报告为无病变的高分辨率MRI患者的术后数据进行了审查。如果在多学科术前患者管理会议上发现与癫痫相关的MRI异常，则患者被重新分类为MRI阳性，或者如果成像保持正常或显示偶然发现，则患者被重新分类为MRI阴性。结果：确定了60名患者; 72%的MRI呈阴性。在原始队列中，中位无癫痫发作持续时间为1.32年（95%置信区间[CI]，0.16-2.0）; 2年时无癫痫发作的概率为36%（95% CI，30%-43%）。在MRI阴性组中，中位无癫痫持续时间为1.52年（95% CI，0.12-5.17）; 2年时无癫痫发作的概率为42%（95% CI，33%-50%）。完全切除发作部位和术后无急性发作与无发作时间较长显著相关（风险比4.9，P = 0.004; 95%CI，分别为1.6-16.7和22.1，P <0.001; 95%CI，5.9-94.7）。在患有医学难治性MRI非病灶性颞外癫痫的患者中，详细评估和随后的切除导致42%的患者在2年时无癫痫发作。
BACKGROUND: Surgery is an important therapeutic option in patients with medically refractory epilepsy. The combination of an extratemporal epileptic focus and nonlesional magnetic resonance imaging (MRI) was often believed to portend a poor outcome.OBJECTIVE: To investigate the outcome and analyze potential prognostic predictors in patients without lesions on MRI who underwent extratemporal resections.METHODS: Clinical, presurgical evaluation, invasive monitoring, and postoperative data of patients with high-resolution MRI that was initially reported as nonlesional were reviewed. Patients were reclassified as MRI-positive if an MRI abnormality related to the epilepsy was revealed at the multidisciplinary presurgical patient management conference, or as MRI-negative if imaging remained normal or revealed incidental findings.RESULTS: Sixty patients were identified; 72% were MRI-negative. In the original cohort, the median seizure-free duration was 1.32 years (95% confidence interval [CI], 0.16-2.0); probability of seizure freedom at 2 years was 36% (95% CI, 30%-43%). In the MRI-negative group, the median seizure-free duration was 1.52 years (95% CI, 0.12-5.17); probability of seizure freedom at 2 years was 42% (95% CI, 33%-50%). Complete resection of ictal onset areas and absence of acute postoperative seizures were significantly associated with longer seizure freedom (risk ratio 4.9, P = .004; 95% CI, 1.6-16.7 and 22.1, P < .001; 95% CI, 5.9-94.7, respectively).CONCLUSION: Among patients with medically refractory MRI nonlesional extratemporal epilepsy, detailed evaluation and subsequent resection leads to seizure freedom in 42% of patients at 2 years.