Brno Epilepsy Centre, First Department of Neurology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic.
Epilepsy Behav. 2011 Nov;22(3):537-41. doi: 10.1016/j.yebeh.2011.08.019. Epub 2011 Oct 1.
The aim of this retrospective study was to analyze invasive EEG findings, histopathology, and postoperative outcomes in patients with MRI-negative, PET-positive temporal lobe epilepsy (TLE) (MRI-/PET+TLE) who had undergone epilepsy surgery. We identified 20 patients with MRI-/PET+TLE (8.4% of all patients with TLE who had undergone surgery; 11 men, 9 women). Of the 20 patients, 16 underwent invasive EEG. The temporal pole and hippocampus were involved in the seizure onset zone in 62.5% of the patients. We did not identify a lateral temporal or extratemporal seizure onset in any patient. Of the 20 patients, 17 had follow-up periods >1 year (mean follow-up=3.3 years). At the final follow-up, 70.6% patients were classified as Engel I, 5.8% of patients as Engel II, and 11.8% of patients as Engel III and IV (11.8%). Histopathological evaluation showed no structural pathology in any resected hippocampus in 58% of all evaluated temporal poles. The most common pathology of the temporal pole was focal cortical dysplasia type IA or IB. MRI-/PET+TLE should be delineated from other "nonlesional TLE." The ictal onset in these patients was in each case in the temporal pole or hippocampus, rather than in the lateral temporal neocortex. Standard surgery produced a good postoperative outcome, comparable to that for patients with lesional TLE. Histopathological findings were limited: the most common pathology was focal cortical dysplasia type I.
本回顾性研究旨在分析行癫痫手术的 MRI 阴性、PET 阳性颞叶癫痫(MRI-/PET+TLE)患者的侵袭性脑电图(EEG)结果、组织病理学和术后结果。我们共确定了 20 例 MRI-/PET+TLE 患者(所有行手术治疗的 TLE 患者的 8.4%;11 名男性,9 名女性)。20 例患者中有 16 例行侵袭性 EEG 检查。62.5%的患者致痫区位于颞极和海马。我们未在任何患者中发现颞叶外侧或颞外起始的癫痫发作。20 例患者中有 17 例的随访时间>1 年(平均随访 3.3 年)。末次随访时,70.6%的患者为 Engel I 级,5.8%的患者为 Engel II 级,11.8%的患者为 Engel III 级和 IV 级(11.8%)。组织病理学评估显示,58%的所有评估的颞极中,切除的海马中无结构病变。颞极最常见的病理类型为局灶性皮质发育不良ⅠA型或ⅠB 型。MRI-/PET+TLE 应与其他“非病变性 TLE”区分开来。这些患者的癫痫发作起始部位均在颞极或海马,而不是在外侧颞叶新皮质。标准手术可产生良好的术后结果,与病变性 TLE 患者相当。组织病理学发现有限:最常见的病理类型为局灶性皮质发育不良Ⅰ型。