Failed surgery for epilepsy - A study of persistence and recurrence of seizures following temporal resection
Failed surgery for epilepsy - A study of persistence and recurrence of seizures following temporal resection
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DOI：
10.1093/brain/123.12.2445
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发表时间：
2000-12-01
期刊：
影响因子：
14.5
通讯作者：
Polkey, CE
中科院分区：
文献类型：
--
作者：
Hennessy, MJ;Elwes, RDC;Polkey, CE
从一系列的282个连续的颞叶切除与内侧颞叶硬化症（MTS），胚胎发育不良性神经上皮肿瘤（DNT）或非特异性病理（NSP）的药物难治性癫痫，51例患者有持续或复发性癫痫发作发生至少每月。在这些患者中，44例患者接受了详细的术后癫痫发作评估，包括临床评估、发作间期和发作期EEG以及高分辨率MRI。在20例原始病理的MTS患者中，14例（70%）术后癫痫发作发生在切除的半球，大多数（12例患者）发生在颞区。尽管MRI显示这12例患者中有5例有残留海马，但只有1例患者被认为有癫痫发作，而其余患者的新皮质有癫痫发作的电临床证据。相比之下，五个MTS复发（25%）癫痫发作完全在对侧颞区。在14例非特异性病理的患者中，复发也主要来自同侧半球（64%），但与MTS病例相比，更多的复发来自颞外部位，包括2例有枕叶结构异常的NSP。虽然70%的10例DNT患者术后部分性癫痫发作出现在同侧半球，许多（60%）有证据表明，一个更广泛的疾病与额外的全身性癫痫发作，认知和行为障碍和多灶性和全身性脑电图异常。9例患者（20%）术后即刻无复发期至少1年，其中7例在手术标本中有MTS。在这7例患者中，4例有同侧颞叶癫痫发作，3例有对侧颞叶癫痫发作。总体而言，术后MRI发现很少遗漏病变，少数病例进行了再次手术或认为可能再次手术。尽管颞叶癫痫术前有明确的电临床综合征，但许多患者在手术后立即或远处意外复发。然而，在无癫痫间隔期后复发的患者中，手术瘢痕中成熟的致癫痫性并不被认为是一个重要的主要机制。
From a series of 282 consecutive temporal resections for medically intractable epilepsy associated with mesial temporal sclerosis (MTS), dysembryoplastic neuroepithelial tumour (DNT) or non-specific pathology (NSP), 51 patients had persistent or recurrent seizures occurring at least monthly. Of these patients, 44 underwent detailed assessment of their postoperative seizures, which included clinical evaluation, interictal and ictal EEG and high-resolution MRI, Of the 20 patients with MTS in the original pathology, 14 (70%) had postoperative seizures arising In the hemisphere of the resection, the majority (12 patients) in the temporal region. Although MRI demonstrated residual hippocampus in five of these 12 patients, only one patient was considered to have seizures arising there, whilst the remainder had electroclinical evidence of seizure onset in the neocortex. In contrast, five of the MTS relapses (25%) had seizure onset exclusively in the contralateral temporal region. Among the 14 patients with non-specific pathology, relapse was also predominantly from the ipsilateral hemisphere (64%), but more relapsed from extratemporal sites compared with the MTS cases, including two with NSP who had occipital structural abnormalities. Although 70% of the 10 patients with DNT had postoperative partial seizures arising in the ipsilateral hemisphere, many (60%) had evidence of a more diffuse disorder with additional generalized seizures, cognitive and behavioural disturbance and multifocal and generalized EEG abnormalities. Nine patients (20%) had immediate postoperative seizure-free periods of at least 1 year, and seven of these had MTS in the operative specimen. Of these seven patients, four had ipsilateral temporal seizures and three had contralateral temporal seizures. Overall, few missed lesions were discovered on postoperative MRI and reoperations were performed or considered possible in a minority of cases. Despite well-defined preoperative electroclinical syndromes of temporal lobe epilepsy, many patients relapsed unexpectedly, either immediately or remotely from the time of surgery. Maturing epileptogenicity in a surgical scar was not, however, considered to be a significant primary mechanism in patients who relapsed after a seizure-free interval.