Long-term epilepsy surgery outcomes in patients with PET-positive, MRI-negative temporal lobe epilepsy
Long-term epilepsy surgery outcomes in patients with PET-positive, MRI-negative temporal lobe epilepsy
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DOI：
10.1016/j.yebeh.2014.09.054
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发表时间：
2014-12-01
影响因子：
2.6
通讯作者：
Zheng, Zhi-Yong
中科院分区：
文献类型：
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作者：
Yang, Peng-Fan;Pei, Jia-Sheng;Zheng, Zhi-Yong
本研究比较了颞叶前部切除术（ATL）治疗同侧颞叶PET低代谢和非病灶性磁共振成像（PET+/MRI-）的难治性颞叶癫痫（TLE）患者与MRI显示内侧颞叶硬化症（MTS）患者的长期疗效。我们描述了28例PET+/MRI-无发作期和间期脑电图（EEG）不一致的医学难治性部分癫痫患者（2004-2007）在避免颅内监测的情况下接受ATL的电临床、MRI、病理特征和癫痫发作结果。主要转归是PET+/MRI-患者2年和5年Engel I级转归的百分比与MRI MTS患者的百分比；神经心理测试作为次要观察指标。2年随访时，PET+/MRI-组有21例（75%）患者为Engel I级，而MTS组有66例（75.9%）；5年随访时，PET+/MRI-组有20例（71.4%）患者为Engel I级，而MTS组有64例（73.6%）患者为Engel I级，两组间无显著差异。我们的结论是，正常的MRI结果不应排除对难治性TLE患者的术前评估，因为良好的术后长期癫痫发作结果是可能的，特别是在单侧前间期癫痫样放电和同侧颞叶PET代谢低下的患者中。(C) 2014爱思唯尔公司版权所有。
This study compared the long-term efficacy of anterior temporal lobectomy (ATL) for the treatment of medically refractory temporal lobe epilepsy (TLE) in patients who presented with ipsilateral temporal PET hypometabolism and nonlesional magnetic resonance imaging (PET+/MRI-) with that in patients who hadmesial temporal sclerosis (MTS) on MRI. We described the electroclinical, MRI, PET, and pathological characteristics and seizure outcome of 28 PET+/MRI- patients without discordant ictal and interictal electroencephalography (EEG) who underwent ATL (2004-2007) for medically refractory partial epilepsy while avoiding intracranial monitoring. The primary outcome was the percentages of Engel Class I outcomes at 2 and 5 years of PET+/MRI- patients compared with those of patients with MTS on MRI; neuropsychological testing was used as the secondary outcome. At 2-year follow-up, 21 (75%) patients in the PET+/MRI- group were in Engel Class I compared with 66 (75.9%) patients with MTS, and at 5-year follow-up, 20 (71.4%) patients in the PET+/MRI- group were in Engel Class I compared with 64 (73.6%) patients in the group with MTS. There were no significant differences between the groups at either time period. We concluded that normal MRI results should not preclude presurgical evaluations in patients with medically refractory TLE, as favorable long-term postoperative seizure outcomes are possible, especially in patients with unilateral anterior interictal epileptiform discharges and ipsilateral temporal PET hypometabolism. (C) 2014 Elsevier Inc. All rights reserved.