Edwards J C, Wyllie E, Ruggeri P M, Bingaman W, Lüders H, Kotagal P, Dinner D S, Morris H H, Prayson R A, Comair Y G
Department of Neurology, Cleveland Clinic Foundation, OH 44195, USA.
Neurology. 2000 Oct 24;55(8):1110-4. doi: 10.1212/wnl.55.8.1110.
To explore seizure outcome after surgery for focal epilepsy due to malformation of cortical development (MCD), with focus on the role of MRI.
Thirty-five patients who had surgery for intractable focal epilepsy due to MCD identified by preoperative MRI and confirmed by histopathologic analysis of resected tissue were studied. Patients were aged 3 months to 47 years (median, 14 years) at the time of surgery. Duration of follow-up was 1 to 7.9 (mean, 3.4) years.
At latest follow-up, 17 patients (49%) had Engel Class I outcome with no seizures or auras only; eight patients (23%) had Class II outcome, with rare disabling seizures; seven patients (20%) had worthwhile improvement; and three patients (9%) had no improvement. Seizure-free outcome tended to be more frequent among patients who had complete resection of unilateral MCD (excluding hemimegalencephaly) based on postoperative MRI (7/12; 58%), compared with patients with unilateral MCD who had incomplete resection (3/11; 27%), but the difference was not significant. The frequency of seizure-free outcome did not differ significantly between children (8/14; 57%), adolescents (7/15; 47%) or adults (2/6; 33%); between patients who had daily (12/24; 50%), weekly (4/9; 44%), or monthly (1/2; 50%) seizures preoperatively; between patients who had temporal (2/6; 33%) or extratemporal or multilobar resections (14/28; 50%); or between patients who were (9/16; 56%) or were not (8/19; 42%) studied with subdural electrodes. Results for all analyses were similar when analyzed at latest available follow-up or at 1 year after surgery.
Surgery can offer seizure-free outcome for approximately one half of carefully selected patients with intractable focal epilepsy due to MCD. Complete resection of the MRI-apparent lesion may improve the likelihood for favorable outcome. MRI evidence of hemimegalencephaly or bilateral MCD suggests a low likelihood for postoperative freedom from seizures.
探讨皮质发育畸形（MCD）所致局灶性癫痫手术后的癫痫发作结局，重点关注磁共振成像（MRI）的作用。
对35例因MCD导致难治性局灶性癫痫而接受手术的患者进行研究，术前MRI确诊并经切除组织的组织病理学分析证实。手术时患者年龄为3个月至47岁（中位数14岁）。随访时间为1至7.9年（平均3.4年）。
在最近一次随访时，17例患者（49%）达到恩格尔I级结局，即无癫痫发作或仅有先兆；8例患者（23%）达到II级结局，有罕见的致残性癫痫发作；7例患者（20%）有显著改善；3例患者（9%）无改善。根据术后MRI显示，单侧MCD（不包括半侧巨脑回）完全切除的患者中无癫痫发作结局更为常见（7/12；58%），而单侧MCD不完全切除的患者中则较少（3/11；27%），但差异无统计学意义。儿童（8/14；57%）、青少年（7/15；47%）或成人（2/6；33%）之间无癫痫发作结局的频率无显著差异；术前每日（12/24；50%）、每周（4/9；44%）或每月（1/2；50%）发作的患者之间无显著差异；颞叶（2/6；33%）或颞叶外或多叶切除的患者之间无显著差异（14/28；50%）；接受或未接受硬膜下电极检查的患者之间无显著差异（9/16；56%对8/19；42%）。在最近一次可用随访或手术后1年进行分析时，所有分析结果均相似。
手术可为精心挑选的约一半因MCD导致难治性局灶性癫痫的患者提供无癫痫发作结局。MRI上明显病变的完全切除可能会提高良好结局的可能性。半侧巨脑回或双侧MCD的MRI证据提示术后无癫痫发作的可能性较低。
