Uijl Sabine G, Leijten Frans S S, Arends Johan B A M, Parra Jaime, van Huffelen Alexander C, Moons Karel G M
Department of Clinical Neurophysiology, Rudolf Magnus Institute of Neuroscience and University Medical Center Utrecht, Utrecht, The Netherlands.
Epilepsia. 2008 Aug;49(8):1317-23. doi: 10.1111/j.1528-1167.2008.01695.x. Epub 2008 Jun 28.
Although several independent predictors of seizure freedom after temporal lobe epilepsy surgery have been identified, their combined predictive value is largely unknown. Using a large database of operated patients, we assessed the combined predictive value of previously reported predictors included in a single multivariable model.
The database comprised a cohort of 484 patients who underwent temporal lobe surgery for drug-resistant epilepsy. Good outcome was defined as Engel class 1, one year after surgery. Previously reported independent predictors were tested in this cohort. To be included in our final prediction model, predictors had to show a multivariable p-value of <0.20.
The final multivariable model included predictors obtained from the patient's history (absence of tonic-clonic seizures, absence of status epilepticus), magnetic resonance imaging [MRI; ipsilateral mesial temporal sclerosis (MTS), space occupying lesion], video electroencephalography (EEG; absence of ictal dystonic posturing, concordance between MRI and ictal EEG), and fluorodeoxyglucose positron emission tomography (FDG-PET; unilateral temporal abnormalities), that were related to seizure freedom in our data. The model showed an expected receiver-operating characteristic curve (ROC) area of 0.63 [95% confidence interval (CI) 0.57-0.68] for new patient populations. Intracranial monitoring and surgery-related parameters (including histology) were not important predictors of seizure freedom. Among patients with a high probability of seizure freedom, 85% were seizure-free one year after surgery; however, among patients with a high risk of not becoming seizure-free, still 40% were seizure-free one year after surgery.
We could only moderately predict seizure freedom after temporal lobe epilepsy surgery. It is particularly difficult to predict who will not become seizure-free after surgery.
尽管已经确定了颞叶癫痫手术后无癫痫发作的几个独立预测因素，但其综合预测价值在很大程度上尚不清楚。我们使用一个大型手术患者数据库，评估了纳入单一多变量模型的先前报道的预测因素的综合预测价值。
该数据库包括一组484例因药物难治性癫痫接受颞叶手术的患者。良好结局定义为术后一年Engel 1级。在该队列中对先前报道的独立预测因素进行了测试。要纳入我们的最终预测模型，预测因素的多变量p值必须<0.20。
最终的多变量模型包括从患者病史中获得的预测因素（无强直阵挛发作、无癫痫持续状态）、磁共振成像[MRI；同侧颞叶内侧硬化（MTS）、占位性病变]、视频脑电图（EEG；无发作期张力障碍姿势、MRI与发作期EEG之间的一致性）以及氟脱氧葡萄糖正电子发射断层扫描（FDG-PET；单侧颞叶异常），这些在我们的数据中与无癫痫发作相关。该模型对新患者群体显示出预期的受试者工作特征曲线（ROC）面积为0.63 [95%置信区间（CI）0.57 - 0.68]。颅内监测和手术相关参数（包括组织学）不是无癫痫发作的重要预测因素。在无癫痫发作可能性高的患者中，85%在术后一年无癫痫发作；然而，在无癫痫发作可能性低的患者中，仍有40%在术后一年无癫痫发作。
我们只能适度预测颞叶癫痫手术后的无癫痫发作情况。尤其难以预测哪些患者术后不会无癫痫发作。
