Carrette Evelien, Vonck Kristl, De Herdt Veerle, Van Dycke Annelies, El Tahry Riëm, Meurs Alfred, Raedt Robrecht, Goossens Lut, Van Zandijcke Michel, Van Maele Georges, Thadani Vijay, Wadman Wytse, Van Roost Dirk, Boon Paul
Reference Center for Refractory Epilepsy, Department of Neurology, Ghent University Hospital, Belgium.
Clin Neurol Neurosurg. 2010 Feb;112(2):118-26. doi: 10.1016/j.clineuro.2009.10.017. Epub 2009 Dec 11.
This is a descriptive study of patients who underwent invasive video-EEG monitoring (IVEM) at Ghent University Hospital. The aim of the study is to identify predictive factors for outcome of IVEM and resective surgery (RS). These factors may optimize the patient flow following the non-invasive presurgical evaluation towards IVEM and RS or other treatments.
Over the past 16 years, 68/710 refractory epilepsy patients included in the presurgical evaluation protocol (M/F 41/27, mean age 33 years) underwent IVEM at Ghent University Hospital. Patient features and follow-up data were collected from the patients' medical files and the electronic patient database at the neurology and neurosurgery department. Predictive factors for IVEM outcome were identified by comparing features of patients with a positive IVEM outcome (i.e. ictal onset zone identification) and patients with a negative IVEM outcome. Predictive factors for RS outcome were identified by comparing features of patients with Engel class I and patients with Engel class II-IV outcome.
In 56/68 patients (82%) IVEM outcome was positive. The occurrence of a seizure-free interval in the patient's history and a non-localizing ictal scalp EEG in patients with a structural abnormality on MRI (p<0.05) were predictive factors for a negative IVEM outcome. 32/68 patients underwent RS. In 22/32 (70%) patients RS resulted in an Engel class I outcome. A structural abnormality on MRI was a predictive factor for a positive RS outcome in patients in whom a focal or regional focus was resected (p<0.05).
This study shows that IVEM identifies one or more ictal onset zone(s) in up to 80% of patients. The potential of IVEM to identify the ictal onset zone is unlikely in patients with a seizure-free interval in their medical history and a non-localizing ictal scalp EEG during the non-invasive presurgical evaluation. Half of these patients underwent RS with long-term seizure freedom in 70%. Patients with structural MRI lesions have the highest chance of seizure freedom. These findings may contribute to the optimization of patient management during both the invasive and non-invasive presurgical work-up.
这是一项对在根特大学医院接受侵入性视频脑电图监测（IVEM）的患者的描述性研究。该研究的目的是确定IVEM和切除性手术（RS）结果的预测因素。这些因素可能会优化在从无创术前评估到IVEM和RS或其他治疗的患者流程。
在过去16年中，根特大学医院对68名/710名纳入术前评估方案的难治性癫痫患者（男/女41/27，平均年龄33岁）进行了IVEM。从患者的病历以及神经科和神经外科的电子患者数据库中收集患者特征和随访数据。通过比较IVEM结果为阳性（即确定发作起始区）的患者和IVEM结果为阴性的患者的特征，确定IVEM结果的预测因素。通过比较恩格尔分级为I级的患者和恩格尔分级为II - IV级的患者的特征，确定RS结果的预测因素。
68名患者中有56名（82%）IVEM结果为阳性。患者病史中出现无癫痫发作间期以及MRI有结构异常的患者发作期头皮脑电图无定位表现（p<0.05）是IVEM结果为阴性的预测因素。68名患者中有32名接受了RS。32名患者中有22名（70%）RS后达到恩格尔I级结果。对于切除了局灶性或区域性病灶的患者，MRI上的结构异常是RS结果为阳性的预测因素（p<0.05）。
本研究表明，IVEM在高达80%的患者中可确定一个或多个发作起始区。对于病史中有无癫痫发作间期且在无创术前评估期间发作期头皮脑电图无定位表现的患者，IVEM确定发作起始区的可能性不大。这些患者中有一半接受了RS，70%实现了长期无癫痫发作。MRI有结构病变的患者无癫痫发作的几率最高。这些发现可能有助于优化侵入性和非侵入性术前检查期间的患者管理。
