Bien Christian G, Szinay Miriam, Wagner Jan, Clusmann Hans, Becker Albert J, Urbach Horst
Department of Epileptology, University of Bonn, Bonn, Germany.
Arch Neurol. 2009 Dec;66(12):1491-9. doi: 10.1001/archneurol.2009.283.
To explore several characteristics of patients with pharmacoresistant epilepsy without distinct lesions on magnetic resonance images (MRI(-)), who account for a relevant proportion of presurgical patient cohorts.
Retrospective case series.
University epilepsy center.
A cohort of 1200 patients who had comprehensive presurgical assessment from January 1, 2000, through December 31, 2006.
Frequency of MRI(-) patients in the total presurgical cohort, seizure-free outcome rates in patients who had surgery and those who did not, outcome predictors, and spatial properties of epileptogenic areas in MRI(-) patients with epilepsy. All MRI(-) patients were retrospectively analyzed. Presurgical MRIs were reevaluated for subtle cortical dysplasias by postprocessing and visual reassessment.
One-hundred ninety MRI(-) patients were identified (16% of all presurgical candidates); 29 (15%) had surgery. Eleven (38%) became seizure free (including those with auras only; 45%). Surgical therapy was more frequently offered to MRI(+) patients (76%; P < .001), and their outcome was also superior (66% seizure-free; P = .001). The seizure-free rate of 16% in MRI(-) patients who did not have surgery was, however, inferior to that of the MRI(-) patients who did (P = .008). Nine MRI(-) patients who had surgery had distinct histopathological lesions, 8 of which turned out to be retrospectively detectable on presurgical MRI. Seven of the MRI(-) but histopathologically lesional patients became seizure free compared with only 4 of 20 patients without histopathological lesions (P = .003). Three-fifths of the histopathologically nonlesional patients had multifocal or extensive epileptogenic areas.
Patients with epilepsy who are MRI(-) can be successfully treated with surgery. Improved sensitivity of MRI will improve the outcomes of presurgically studied patients. Surgical failures in patients without histopathological lesions mostly result from extensive epileptogenic areas.
探讨磁共振成像（MRI）无明显病变的药物难治性癫痫患者的一些特征，这类患者在术前患者队列中占相当比例。
回顾性病例系列研究。
大学癫痫中心。
一组1200例患者，他们在2000年1月1日至2006年12月31日期间接受了全面的术前评估。
术前队列中MRI无病变患者的频率、接受手术和未接受手术患者的无癫痫发作结局率、结局预测因素以及MRI无病变癫痫患者致痫区的空间特性。对所有MRI无病变患者进行回顾性分析。通过后处理和视觉重新评估对术前MRI进行重新评估，以发现细微的皮质发育异常。
确定了190例MRI无病变患者（占所有术前候选患者的16%）；29例（15%）接受了手术。11例（38%）实现无癫痫发作（包括仅伴有先兆的患者；45%）。MRI有病变的患者更常接受手术治疗（76%；P <.001），且他们的结局也更好（无癫痫发作率为66%；P =.001）。然而，未接受手术的MRI无病变患者的无癫痫发作率为16%，低于接受手术的MRI无病变患者（P =.008）。9例接受手术的MRI无病变患者有明显的组织病理学病变，其中8例在术前MRI上经回顾性分析可检测到。7例MRI无病变但有组织病理学病变的患者实现无癫痫发作，而20例无组织病理学病变的患者中只有4例（P =.003）。五分之三的无组织病理学病变患者有多处或广泛的致痫区。
MRI无病变的癫痫患者可通过手术成功治疗。提高MRI的敏感性将改善术前研究患者的结局。无组织病理学病变患者的手术失败大多源于广泛的致痫区。
