Failed surgery for temporal lobe epilepsy: Predictors of long-term seizure-free course
Failed surgery for temporal lobe epilepsy: Predictors of long-term seizure-free course
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DOI：
10.1016/j.eplepsyres.2005.02.004
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发表时间：
2005-03-01
影响因子：
2.2
通讯作者：
Ebner, A
中科院分区：
文献类型：
--
作者：
Janszky, J;Pannek, HW;Ebner, A
目的：确定预测TLE术后2年预后的预后因素，这些患者在术后6个月检查时没有癫痫发作。方法：我们纳入了86例术后TLE患者，他们接受了术前评估，包括视频脑电图和高分辨率MRI，并在术后2至6个月内发生癫痫发作。结果：32%的患者术后第二年无癫痫发作。我们发现，术前正常的MRI检查结果和继发性全面性癫痫发作（SGTCS）与非无癫痫发作相关，而术后罕见的癫痫发作和同侧颞叶IED与无癫痫发作相关。新给药左乙拉西坦对术后预后有显著的积极影响，不受其他预后因素的影响。接受左乙拉西坦治疗的7例患者中有5例无癫痫发作（p = 0.006）。结论：术后未立即无癫痫发作的患者中，有三分之一最终实现了长期无癫痫发作。我们建议癫痫手术失败后观察长期癫痫发作自由，特别是术后罕见癫痫发作、局灶性MRI异常、同侧颞峰或术前无SGTCS的患者。左乙拉西坦可能对术后癫痫发作有积极作用。(c) 2005年Elsevier B.V.出版
Objectives: To identify prognostic factors which predict the outcome 2 years after TLE surgery in those patients who were not seizure-free at the 6-month postoperative examination.Methods: We included 86 postoperative TLE patients who had undergone presurgical evaluation, including video-EEG and high-resolution MRI, and who had seizures between the second and sixth postoperative months.Results: 32% of patients were seizure-free in the second postoperative year. We found that normal MRI findings and secondarily generalized seizures (SGTCS) preoperatively were associated with a non-seizure-free outcome, while rare postoperative seizures and ipsilateral temporal IED with seizure-free outcome. Newly administered levetiracetam showed a significant positive effect on the postoperative outcome independent of other prognostic factors. Five of seven patients who received levetiracetam became seizure-free (p = 0.006).Conclusion: One-third of patients who did not become seizure-free immediately after surgery, eventually achieved long-term seizure freedom. We suggest watching for long-term seizure freedom after failed epilepsy surgery especially in patients who had rare postoperative seizures, focal MRI abnormality, ipsilateral temporal spikes, or no SGTCS preoperatively. Levetiracetam may have a positive effect on postsurgical seizures. (c) 2005 Published by Elsevier B.V.