Surgical resection for intractable epilepsy in "double cortex" syndrome yields inadequate results
Surgical resection for intractable epilepsy in "double cortex" syndrome yields inadequate results
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DOI：
10.1046/j.1528-1157.2001.39900.x
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发表时间：
2001-09-01
期刊：
影响因子：
5.6
通讯作者：
Andermann, F
中科院分区：
文献类型：
--
作者：
Bernasconi, A;Martinez, V;Andermann, F
目的：分析结果的手术治疗顽固性癫痫患者皮质下带异位，或双皮质综合征，弥漫性neuronal migration disorder.Methods：我们研究了8例（5名妇女）与双皮质综合征和顽固性癫痫。所有患者均进行了全面的术前评估，包括长时间的视频脑电图记录和磁共振成像（MRI）。神经系统检查均正常。其中三人智力正常，五人轻度弱智。6例患者进行了侵入性EEG记录，其中3例使用硬膜下网格，3例使用立体定向植入深度电极（SEEG）。虽然脑电图记录显示多叶癫痫异常，在大多数患者中，区域或局灶性癫痫发作记录在所有。MRI显示双侧皮质下条索异位，3例厚度不对称。在一名患者中发现了左额叶皮质增厚的额外区域。手术包括2例患者的多处软膜下横断，1例额叶病变切除术，5例颞叶切除术和杏仁核切除术，1例额外的前部胼胝体切开术。5例患者没有显着改善，两个有一定的改善，一个是大大improved.Conclusion：我们的研究结果不支持局灶性手术切除致癫痫组织的双皮质综合征患者，即使在存在一个相对局部的致癫痫区。
Purpose: To analyze the results of surgical treatment of intractable epilepsy in patients with subcortical band heterotopia, or double cortex syndrome, a diffuse neuronal migration disorder.Methods: We studied eight patients (five women) with double cortex syndrome and intractable epilepsy. All had a comprehensive presurgical evaluation including prolonged video-EEG recordings and magnetic resonance imaging (MRI).Results: All patients had partial seizures, with secondary generalization in six of them. Neurologic examination was normal in all. Three were of normal intelligence, and five were mildly retarded. Six patients underwent invasive EEG recordings, three of them with subdural grids and three with stereotactic implanted depth electrodes (SEEG). Although EEG recordings showed multilobar epileptic abnormalities in most patients, regional or focal seizure onset was recorded in all. MRI showed bilateral subcortical band heterotopia, asymmetric in thickness in three. An additional area of cortical thickening in the left frontal lobe was found in one patient. Surgical procedures included multiple subpial transections in two patients, frontal lesionectomy in one, temporal lobectomy with amygdalohippocampectomy in five, and an additional anterior callosotomy in one. Five patients had no significant improvement, two had some improvement, and one was greatly improved.Conclusion: Our results do not support focal surgical removal of epileptogenic tissue in patients with double cortex syndrome, even in the presence of a relatively localized epileptogenic area.