McGonigal Aileen, Bartolomei Fabrice, Régis Jean, Guye Maxime, Gavaret Martine, Trébuchon-Da Fonseca Agnès, Dufour Henry, Figarella-Branger Dominique, Girard Nadine, Péragut Jean-Claude, Chauvel Patrick
INSERM, U 751, Laboratoire de Neurophysiologie et Neuropsychologie, Marseille, F-13000, France.
Brain. 2007 Dec;130(Pt 12):3169-83. doi: 10.1093/brain/awm218. Epub 2007 Sep 12.
According to most existing literature, the absence of an MRI lesion is generally associated with poorer prognosis in resective epilepsy surgery. Delineation of the epileptogenic zone (EZ) by intracranial recording is usually required but is perceived to be more difficult in 'MRI negative' cases. Most previous studies have used subdural recording and there is relatively less published data on stereoelectroencephalography (SEEG). The objective of this study was to report the experience of our group in using SEEG in presurgical evaluation, comparing its effectiveness in normal and lesional MRI cases. One hundred consecutive patients undergoing SEEG for presurgical assessment were studied. Forty-three patients out of one hundred (43%) had normal MRI and 57 (57%) had lesional MRI. Successful localization was achieved with no difference between these two groups, in 41/43 (95%) normal MRI and in 55/57 (96%) lesional MRI cases (P = 1.00). Surgery was proposed in 84/100 patients and contraindicated in 16/100 with no significant difference between lesional and MRI-negative groups (P > 0.05). At 1 year follow-up, 11/20 (55%) of those having undergone cortectomy in the MRI-negative group and 21/40 (53%) in the lesional MRI group were entirely seizure free (P > 0.05) and these proportions were maintained at 2 years follow-up. Significant improvement in seizure control (ILAE outcome groups 1-4) was achieved in >90% cases with no difference between groups (P > 0.05). Of MRI-negative cases that underwent surgery, 10/23 (43%) had focal cortical dysplasia. This series showed that SEEG was equally effective in the presurgical evaluation of MRI-negative and lesional epilepsies.
根据大多数现有文献，在切除性癫痫手术中，磁共振成像（MRI）未发现病变通常与较差的预后相关。通常需要通过颅内记录来划定致痫区（EZ），但在“MRI阴性”病例中，这一过程被认为更加困难。以往大多数研究采用硬膜下记录，而关于立体定向脑电图（SEEG）的已发表数据相对较少。本研究的目的是报告我们团队在术前评估中使用SEEG的经验，比较其在MRI正常和有病变病例中的有效性。对连续100例接受SEEG进行术前评估的患者进行了研究。100例患者中有43例（43%）MRI正常，57例（57%）MRI有病变。两组之间在成功定位方面无差异，43例MRI正常的患者中有41例（95%）成功定位，57例有病变的患者中有55例（96%）成功定位（P = 1.00）。100例患者中有84例建议进行手术，16例不适合手术，有病变组和MRI阴性组之间无显著差异（P > 0.05）。在1年随访时，MRI阴性组中接受皮质切除术的患者有11/20（55%）完全无癫痫发作，有病变的MRI组中为21/40（53%）完全无癫痫发作（P > 0.05），且这些比例在2年随访时保持不变。超过90%的病例在癫痫控制方面有显著改善（国际抗癫痫联盟（ILAE）结果分组1 - 4级），两组之间无差异（P > 0.05）。在接受手术的MRI阴性病例中，10/23（43%）有局灶性皮质发育不良。该系列研究表明，SEEG在MRI阴性和有病变的癫痫术前评估中同样有效。
