Yun Chang-Ho, Lee Sang Kun, Lee Seo Young, Kim Kwang Ki, Jeong Sang Wook, Chung Chun-Ki
Department of Neurology, Inha University College of Medicine, Incheon, South Korea.
Epilepsia. 2006 Mar;47(3):574-9. doi: 10.1111/j.1528-1167.2006.00470.x.
Defining prognostic factors for neocortical epilepsy surgery is important for the identification of ideal candidates and for predicting the prognosis of individual patients. We use multivariate analysis to identify favorable prognostic factors for neocortical epilepsy surgery.
One hundred ninety-three neocortical epilepsy patients, including 91 without focal lesions on MRI, were included. Sixty-one had frontal lobe epilepsy (FLE), 80 had neocortical temporal lobe epilepsy (nTLE), 21 had parietal lobe epilepsy (PLE), and 22 had occipital lobe epilepsy (OLE). The primary outcome variable was patient status >or=2 years after surgery (i.e., seizure free or not). Clinical characteristics and the recent presurgical diagnostic modalities were considered as probable prognostic factors. Univariate and standard multiple logistic regression analyses were used to identify favorable prognostic factors.
The seizure-free rate was 57.5%. By univariate analysis, a focal lesion on MRI, localized ictal onset on surface EEG, epilepsies other than FLE, localized hypometabolism on fluorodeoxyglucose-positron emission tomography (FDG-PET), and pathologies other than cortical dysplasia were significantly associated with a seizure-free outcome (p<0.05). Multivariate analysis revealed that a focal lesion on MRI (p=0.003), correct localization by FDG-PET (p=0.007), and localized ictal onset on EEG (p=0.01) were independent predictors of a good outcome.
The presence of a focal lesion on MRI, correct localized hypometabolism on FDG-PET, or localized ictal rhythms on EEG were identified as predictors of a seizure-free outcome. Our results suggest that these findings allow the selection of better candidates for neocortical epilepsy surgery.
确定新皮质癫痫手术的预后因素对于识别理想的手术候选人以及预测个体患者的预后非常重要。我们采用多变量分析来确定新皮质癫痫手术的有利预后因素。
纳入193例新皮质癫痫患者，其中91例MRI上无局灶性病变。61例为额叶癫痫（FLE），80例为新皮质颞叶癫痫（nTLE），21例为顶叶癫痫（PLE），22例为枕叶癫痫（OLE）。主要结局变量为术后≥2年的患者状态（即无癫痫发作或有癫痫发作）。临床特征和近期术前诊断方式被视为可能的预后因素。采用单变量和标准多元逻辑回归分析来确定有利的预后因素。
无癫痫发作率为57.5%。单变量分析显示，MRI上的局灶性病变、表面脑电图上的局限性发作起始、FLE以外的癫痫、氟脱氧葡萄糖-正电子发射断层扫描（FDG-PET）上的局限性代谢减低以及皮质发育异常以外的病理改变与无癫痫发作结局显著相关（p<0.05）。多变量分析显示，MRI上的局灶性病变（p=0.003）、FDG-PET正确定位（p=0.007）以及脑电图上的局限性发作起始（p=0.01）是良好结局的独立预测因素。
MRI上存在局灶性病变、FDG-PET上正确的局限性代谢减低或脑电图上的局限性发作节律被确定为无癫痫发作结局的预测因素。我们的结果表明，这些发现有助于为新皮质癫痫手术选择更好的候选人。
