R. Madhavan Nayar Center for Comprehensive Epilepsy Care, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.
Neurology. 2011 May 31;76(22):1925-31. doi: 10.1212/WNL.0b013e31821d74b3.
To assess the value of postoperative EEG in predicting seizure outcome and seizure recurrence following antiepileptic drug (AED) withdrawal in patients with mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS).
We studied 262 consecutive patients with MTLE-HS with serial EEGs at 3 months, and at 1, 2, and 3 years after anterior temporal lobectomy (ATL), and considered the presence of interictal epileptiform discharges (IED) as abnormal. We attempted AED withdrawal in all seizure-free patients. We defined favorable outcome as freedom from seizures/auras during the entire follow-up period (outcome 1) and during terminal 1-year follow-up (outcome 2).
During mean follow-up period of 7.6 (range 5-12) years, 129 (49.2%) patients had favorable outcome 1 and 218 (83.2%) had favorable outcome 2. Of 225 (85.9%) patients in whom AED withdrawal was attempted, 61 (27.1%) had seizure recurrence. Compared to patients with normal EEG, those with IED on 1-year post-ATL EEG had a 3-fold increased risk for unfavorable outcome 1 and 7-fold increased risk for unfavorable outcome 2. The patients in whom all the 4 EEGs were abnormal had 9-fold odds for unfavorable outcome 1 and 26-fold odds for unfavorable outcome 2. An abnormal EEG at 1 year increased the risk of seizure recurrence following AED withdrawal by 2.6-fold.
Post-ATL EEG predicts seizure outcome and seizure recurrence following AED withdrawal. Serial EEGs predict outcome better than single EEG. This information will be helpful in counseling of patients after ATL, and in making rational decisions on AED withdrawal.
评估术后脑电图在预测抗癫痫药物（AED）停药后伴有海马硬化的内侧颞叶癫痫（MTLE-HS）患者的癫痫发作结局和复发中的价值。
我们研究了 262 例连续的 MTLE-HS 患者，在接受前颞叶切除术（ATL）后 3 个月、1 年、2 年和 3 年进行了连续脑电图检查，并将发作间期癫痫样放电（IED）视为异常。我们试图让所有无癫痫发作的患者停用 AED。我们将良好的结局定义为整个随访期间（结局 1）和末次随访 1 年期间（结局 2）无癫痫发作/先兆。
在平均 7.6 年（5-12 年）的随访期间，129 例（49.2%）患者结局 1 良好，218 例（83.2%）患者结局 2 良好。在尝试停用 AED 的 225 例（85.9%）患者中，61 例（27.1%）出现癫痫发作复发。与脑电图正常的患者相比，ATL 后 1 年 EEG 有 IED 的患者结局 1 不良的风险增加 3 倍，结局 2 不良的风险增加 7 倍。所有 4 次脑电图均异常的患者结局 1 不良的几率增加 9 倍，结局 2 不良的几率增加 26 倍。1 年时的异常脑电图使 AED 停药后癫痫发作复发的风险增加 2.6 倍。
ATL 后脑电图可预测癫痫发作结局和 AED 停药后癫痫复发。脑电图比单次脑电图更能预测结局。这些信息将有助于对 ATL 后患者进行咨询，并做出合理的 AED 停药决策。
