Seizure outcome after anterior temporal lobectomy and its predictors in patients with apparent temporal lobe epilepsy and normal MRI
Seizure outcome after anterior temporal lobectomy and its predictors in patients with apparent temporal lobe epilepsy and normal MRI
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DOI：
10.1111/j.0013-9580.2004.48503.x
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发表时间：
2004-07-01
期刊：
影响因子：
5.6
通讯作者：
Sarma, PS
中科院分区：
文献类型：
--
作者：
Sylaja, PN;Radhakrishnan, K;Sarma, PS
目的：关于前颞叶切除术（ATL）的作用、最佳术前评估策略、ATL后癫痫发作结局以及预测医学难治性颞叶癫痫（TLE）和正常高分辨率磁共振成像（MRI）患者结局的因素，几乎没有可靠的信息。为了具有成本效益，发展中国家的癫痫手术中心必须利用当地现有的技术和专业知识来选择癫痫手术的候选人。研究方法：我们回顾了17例接受ATL治疗的难治性TLE患者的电临床和病理学特征以及癫痫发作结局，这些患者是在无创选择方案的基础上选择接受ATL治疗的，尽管术前高分辨率MRI正常，但没有正电子发射断层扫描（PET）或单光子发射计算机断层扫描（SPECT）的帮助。结果：7例（41%）患者获得了极好的癫痫发作结局，其中5例完全无癫痫发作。另外5名（29%）患者的癫痫发作频率降低>75%。以下前ATL因素预测了一个很好的结果：既往病史的热性惊厥，严格的单侧前颞叶发作间期癫痫样放电（IEDs），和一致的I型发作脑电图模式。病理证实海马结构神经元丢失的5例患者均无癫痫发作。后颞部、双侧颞部和全身性IED的存在预示着ATL后癫痫发作的不良结局。结论：通过病史和头皮记录的发作间期和发作EEG数据，可以从MRI阴性的TLE患者中选择一个亚组的患者，这些患者注定具有良好的ATL后结局。这些患者的属性是先前的历史，热性惊厥，严格的单侧前IED，和一致的I型发作脑电图模式。
Purpose: Very little reliable information is available regarding the role of anterior temporal lobectomy (ATL), optimal presurgical evaluation strategy, post-ATL seizure outcome, and the factors that predict the outcome in patients with medically refractory temporal lobe epilepsy (TLE) and normal high-resolution magnetic resonance imaging (MRI). To be cost-effective, epilepsy surgery centers in developing countries will have to select candidates for epilepsy surgery by using the locally available technology and expertise. Methods: We reviewed the electroclinical and pathological characteristics and seizure outcome of 17 patients who underwent ATL for medically refractory TLE after being selected for ATL based on a noninvasive selection protocol without the aid of positron emission tomography (PET) or single-photon emission computed tomography (SPECT), despite a normal preoperative high-resolution MRI. Results: Seven (41%) patients achieved an excellent seizure outcome; five of them were totally seizure free. An additional five (29%) patients had >75% reduction in seizure frequency. The following pre-ATL factors predicted an excellent outcome: antecedent history of febrile seizures, strictly unilateral anterior temporal interictal epileptiform discharges (IEDs), and concordant type I ictal EEG pattern. All the five patients with pathologically verified hippocampal formation neuronal loss were seizure free. The presence of posterior temporal, bilateral temporal, and generalized IEDs portended unfavorable post-ATL seizure outcome. Conclusions: A subgroup of patients destined to have an excellent post-ATL outcome can be selected from MRI-negative TLE patients by using history and scalp-recorded interictal and ictal EEG data. The attributes of these patients are antecedent history of febrile seizures, strictly unilateral anterior IEDs, and concordant type I ictal EEG pattern.