Northern California Comprehensive Epilepsy Center, San Francisco, San Francisco, CA 94143, USA.
Ann Neurol. 2011 Jul;70(1):151-62. doi: 10.1002/ana.22399. Epub 2011 Jul 14.
Malformations of cortical development (MCDs) are a major cause of medically refractory epilepsy. Our aim was to examine a surgical series of patients with cortical malformations to determine the prognostic factors associated with long-term seizure control.
We conducted a retrospective review of 143 patients with MCD who underwent resective surgery for medically refractory epilepsy. Demographic, imaging, histopathologic, and surgical variables were analyzed for potential association with seizure freedom. Preoperative magnetic resonance imaging (MRI) was evaluated in a blind fashion and classified according to a new imaging/embryologic MCD classification system.
Gray-white blurring on MRI, smaller lesions, complete resection of structural lesions, complete resection of abnormal electrocorticographic areas, and locally confined electrocorticographic abnormalities are favorable prognosticators of seizure freedom on univariate analysis. Imaging features consistent with abnormal proliferation (Barkovich class I) were associated with better outcome compared to those related to abnormal neuronal migration (class II) or abnormal cortical organization (class III). Multivariate logistic regression revealed complete resection of tissue manifesting electrocorticographic and/or MRI anatomic abnormalities as the main independent predictor of seizure freedom. Other histopathologic or demographic factors were not associated with seizure control. Long-term follow-up of patients demonstrated sustained overall rates of seizure control (72% at 2 years, 65% at 5 years, and 67% at 10 years).
Surgery for MCDs can result in high rates of seizure freedom. Complete resection of electrocorticographic and anatomic abnormalities appears to be most predictive of long-term seizure control.
皮质发育畸形（MCD）是导致药物难治性癫痫的主要原因。我们旨在研究一组皮质畸形患者的手术系列，以确定与长期癫痫控制相关的预后因素。
我们对 143 例 MCD 患者进行了回顾性研究，这些患者因药物难治性癫痫而行切除术。对人口统计学、影像学、组织病理学和手术变量进行了分析，以确定与无癫痫发作相关的因素。对术前磁共振成像（MRI）进行了盲法评估，并根据新的影像学/胚胎学 MCD 分类系统进行了分类。
MRI 上的灰白质模糊、病变较小、结构病变的完全切除、异常皮质脑电图区域的完全切除以及局部局限的皮质脑电图异常是无癫痫发作的单因素分析中的有利预后因素。与异常神经元迁移（II 类）或异常皮质组织（III 类）相关的影像学特征与异常增殖（Barkovich 类 I）一致，与更好的结果相关。多变量逻辑回归显示，切除组织中表现出皮质脑电图和/或 MRI 解剖异常是无癫痫发作的主要独立预测因素。其他组织病理学或人口统计学因素与癫痫控制无关。对患者的长期随访显示，总体癫痫控制率持续（2 年时为 72%，5 年时为 65%，10 年时为 67%）。
针对 MCD 的手术可以产生较高的无癫痫发作率。切除皮质脑电图和解剖异常似乎是长期癫痫控制的最主要预测因素。
