Resective temporal lobe surgery in refractory temporal lobe epilepsy: prognostic factors of postoperative seizure outcome
Resective temporal lobe surgery in refractory temporal lobe epilepsy: prognostic factors of postoperative seizure outcome
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DOI：
10.3171/2020.7.jns20284
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发表时间：
2021-09-01
影响因子：
4.1
通讯作者：
Vatter, Hartmut
中科院分区：
文献类型：
--
作者：
Borger, Valeri;Hamed, Motaz;Vatter, Hartmut
目的颞叶癫痫（Temporal lobe epilepsy，TLE）是癫痫最常见的形式之一。在大约30%的患者中，癫痫发作对药物治疗是难治的。尽管近年来现代术前评估取得了很大的成就，但癫痫发作结局的术前预测仍然很困难。本研究的目的是评估癫痫发作的结果与药物难治性TLE患者进行切除颞叶手术（rTLS），并确定与不利的术后癫痫发作outcome.METHODS患者进行了回顾性收集的前瞻性癫痫手术数据库中的药物难治性TLE谁在2012年和2017年之间进行了rTLS相关的功能。对161例患者的临床、影像学、神经心理学、组织病理学和围手术期结果进行了回顾性分析。根据癫痫发作结果将患者分为两组（I组，国际抗癫痫联盟[ILAE] 1级; II组，ILAE ≥ 2级）。为确定术后不良癫痫发作结局（ILAE分级≥ 2）的独立危险因素，进行了多因素logistic回归分析。神经心理学评估表明，左颞叶切除术后的言语记忆和右侧切除术后的非言语记忆中的认知表现损失更为明显，而手术后注意力得到改善。总体而言，术后视野缺损（VFD）很常见，发生在51%的患者中。与非选择性手术患者相比，选择性手术患者的VFD发生率无统计学显著差异。缺乏MRI病变和放置深度电极术前确定为不利的癫痫outcome.CONCLUSIONS预测rTLS是一种有效的治疗方法，在难治性TLE患者。然而，在rTLS之前缺乏MRI病变和放置深部电极的患者发生不利的术后癫痫结局的风险更高。
OBJECTIVE Temporal lobe epilepsy (TLE) is one of the most common forms of epilepsy. In approximately 30% of patients, seizures are refractory to drug treatment. Despite the achievements of modern presurgical evaluation in recent years, the presurgical prediction of seizure outcome remains difficult. The aim of this study was to evaluate the seizure outcome in patients with drug-refractory TLE who underwent resective temporal lobe surgery (rTLS) and to determine features associated with unfavorable postsurgical seizure outcome.METHODS Patients with medically refractory TLE who underwent rTLS between 2012 and 2017 were reviewed from the prospectively collected epilepsy surgery database. A retrospective analysis of clinical, radiological, neuropsychological, histopathological, and perioperative findings of 161 patients was performed. The patients were divided into two groups according to seizure outcome (group I, International League Against Epilepsy [ILAE] class 1; group II, ILAE class >= 2). For identification of independent risk factors for unfavorable postoperative seizure outcome (ILAE class >= 2), a multivariate logistic regression analysis was performed.RESULTS Seizure freedom (ILAE class 1) was achieved in 121 patients (75.2%). The neuropsychological evaluation demonstrated that losses in cognitive performance were more pronounced in verbal memory after resections in the left temporal lobe and in nonverbal memory after right-sided resections, whereas attention improved after surgery. Overall, postoperative visual field deficits (VFDs) were common and occurred in 51% of patients. There was no statistically significant difference in the incidence of VFD in patients with selective surgical procedures compared to the patients with nonselective procedures. The lack of MRI lesions and placement of depth electrodes were preoperatively identified as predictors for unfavorable seizure outcome.CONCLUSIONS rTLS is an effective treatment method in patients with refractory TLE. However, patients with a lack of MRI lesions and placement of depth electrodes prior to rTLS are at higher risk for an unfavorable postsurgical seizure outcome.