Yu Tao, Wang Yuping, Zhang Guojun, Cai Lixin, Du Wei, Li Yongjie
Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, China.
Seizure. 2009 May;18(4):288-92. doi: 10.1016/j.seizure.2008.11.008. Epub 2009 Jan 10.
To assess the role of various pre-surgical evaluations in posterior cortex epilepsy (PCE) and its surgical outcome.
A retrospective analysis of clinical and laboratory data from 43 PCE patients referred for surgery was performed. The diagnosis was established by standard pre-surgical evaluation modalities including semiology, MRI, interictal and ictal scalp video-EEG as well as additional intracranial EEG monitoring in selected cases.
The 43 patients included 11 parietal lobe epilepsies, 13 occipital lobe epilepsies, and 19 patients with seizures originating from parieto-occipito-posterior temporal cortex. Thirty-three (76.7%) patients experienced at least one type of aura. Seventeen patients showed complex focal seizures, which were followed by secondarily generalized tonic-clonic seizures in seven of them; eighteen patients predominantly showed simple motor seizures (clonic seizures in 6, tonic seizures in 7, and versive seizures in 5). Long-term visual field deficits were observed in 8 patients. Other transient neurological deficits occurred in 7 patients. All patients received the follow-up study lasting 1-5 years, and achieved Engel's I in 26 cases, II in 5, III in 5, and IV-V in 7. Malformation of cortical development was diagnosed in 41.9% of our surgical population. No significant relationship was found between the diagnostic accuracy of any pre-surgical evaluating modality and surgical outcome in this series.
Surgical treatment is effective for PCE. Accurate localization of epileptogenic zone and eloquent cortex are two key factors for favorable outcome. None of the diagnostic modalities shows obvious predictive value for favorable surgical outcome.
评估各种术前评估在枕叶后癫痫（PCE）及其手术结果中的作用。
对43例因手术而转诊的PCE患者的临床和实验室数据进行回顾性分析。诊断通过标准的术前评估方式确定，包括症状学、磁共振成像（MRI）、发作间期和发作期头皮视频脑电图，以及在部分病例中进行的额外颅内脑电图监测。
43例患者中包括11例顶叶癫痫、13例枕叶癫痫以及19例发作起源于顶枕颞叶后部皮质的患者。33例（76.7%）患者经历过至少一种类型的先兆。17例患者表现为复杂部分性发作，其中7例随后继发全面性强直阵挛发作；18例患者主要表现为简单运动性发作（6例阵挛发作、7例强直发作、5例旋转性发作）。8例患者出现长期视野缺损。7例患者出现其他短暂性神经功能缺损。所有患者均接受了为期1至5年的随访研究，26例达到Engel I级，5例达到II级，5例达到III级，7例达到IV - V级。在我们的手术人群中，41.9%被诊断为皮质发育畸形。在本系列研究中，未发现任何术前评估方式的诊断准确性与手术结果之间存在显著相关性。
手术治疗对PCE有效。癫痫发作起始区和功能区皮质的准确定位是取得良好结果的两个关键因素。没有一种诊断方式对良好的手术结果显示出明显的预测价值。
