Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland.
Epilepsia. 2010 Nov;51(11):2260-9. doi: 10.1111/j.1528-1167.2010.02720.x. Epub 2010 Sep 24.
The outcome of surgery in patients with temporal lobe epilepsy (TLE) and normal high-resolution magnetic resonance imaging (MRI) has been significantly worse than in patients with unilateral hippocampal damage upon MRI. The purpose of this study was to determine the long-term outcomes of consecutive true MRI-negative TLE patients who all underwent standardized preoperative evaluation with intracranial electroencephalography (EEG) electrodes.
In this study we present all adult MRI-negative TLE surgery candidates evaluated between January 1990 and December 2006 at Kuopio Epilepsy Center in Kuopio University Hospital, which provides a national center for epilepsy surgery in Finland. During this period altogether 146 TLE surgery candidates were evaluated with intracranial electrodes, of whom 64 patients with normal high-resolution MRI were included in this study.
Among the 38 patients who finally underwent surgery, at the latest follow-up (mean 5.8 years), 15 (40%) were free of disabling seizures (Engel class I) and 6 (16%) were seizure-free (Engel class IA). Twenty-one (55%) of 38 patients had poor outcomes (Engel class III-IV). Outcomes did not change compared to 12-month follow-up. Histopathologic examination failed to reveal any focal pathology in 68% of our MR-negative cases. Only patients with noncongruent positron emission tomography (PET) results had worse outcomes (p = 0.044).
Our results suggest that epilepsy surgery outcomes in MRI-negative TLE patients are comparable with extratemporal epilepsy surgery in general. Seizure outcomes in the long-term also remain stable. Modern imaging techniques could further improve the postsurgical seizure-free rate. However, these patients usually require chronic intracranial EEG evaluation to define epileptogenic areas.
颞叶癫痫（TLE）患者的手术结果在磁共振成像（MRI）正常高分辨率的情况下明显差于单侧海马损伤患者。本研究的目的是确定所有接受颅内脑电图（EEG）电极进行标准化术前评估的连续真正 MRI 阴性 TLE 患者的长期结果。
本研究介绍了 1990 年 1 月至 2006 年 12 月在库奥皮奥大学医院库奥皮奥癫痫中心评估的所有成年 MRI 阴性 TLE 手术候选者，该中心是芬兰全国癫痫手术中心。在此期间，共有 146 名 TLE 手术候选者接受了颅内电极评估，其中 64 名具有正常高分辨率 MRI 的患者被纳入本研究。
在最终接受手术的 38 名患者中，在最新随访（平均 5.8 年）时，15 名（40%）无残疾性发作（Engel Ⅰ级），6 名（16%）无发作（Engel ⅠA级）。38 名患者中有 21 名（55%）预后较差（Engel Ⅲ-Ⅳ级）。与 12 个月随访时相比，结果没有变化。组织病理学检查在我们的 68%的 MRI 阴性病例中未能发现任何局灶性病变。只有非一致的正电子发射断层扫描（PET）结果的患者预后较差（p = 0.044）。
我们的结果表明，MRI 阴性 TLE 患者的癫痫手术结果与一般的非颞叶癫痫手术相当。长期的癫痫发作结果也保持稳定。现代成像技术可以进一步提高术后无癫痫发作率。然而，这些患者通常需要进行慢性颅内 EEG 评估以确定致痫区。
