Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03756, USA.
Epilepsia. 2012 Oct;53(10):1746-55. doi: 10.1111/j.1528-1167.2012.03582.x. Epub 2012 Jul 10.
There is still controversy in deciding which patients with frontal lobe epilepsy (FLE) should undergo resective surgery, even though it is a well-established therapy. The aim of this study is to define multiple outcome measures and determine whether there are certain subpopulations of preferred surgical candidates that have a more favorable seizure prognosis.
Fifty-eight patients underwent resective FLE surgery with a mean follow-up period of 79.3 months (range 12-208 months). Patient demographics, clinical seizure characteristics, seizure-onset zone within the frontal lobes, and diagnostic tests were tabulated. Engel class, International League Against Epilepsy (ILAE) class, postoperative seizure patterns, time to first recurrent seizure, and seizures and employment during the last year of follow-up were used as outcome measures. Neuropsychological performance and Beck Depression Inventory (BDI) scores were used to define neuropsychological outcome and examined as predictors of seizure outcome.
Thirty-three (57%) patients with resective surgery had an Engel class I outcome and 29 (50%) had an ILAE class I outcome. Mean time to first seizure after surgery was 33.3 months (range 0-208). Only 14 patients (24%) were completely seizure-free without auras (Engel IA) throughout the entire follow-up period. The most common pattern of seizure recurrence was mixed, with prolonged periods of seizure freedom intermixed with recurrences. In addition, 32% of patients made gains in employment and 52% were able to reduce use of antiepileptic drugs (AEDs), although only 9% discontinued AEDs. No significant association was found between class I or class IA outcome and the presence of a focal magnetic resonance imaging (MRI) abnormality, any specific localization of seizure focus within the frontal lobe, or neuropsychological change.
Findings indicate that that long-term outcome is generally favorable in FLE resective surgery, and support the need for considering multiple outcome measures to more fully characterize clinically relevant postsurgical changes. Outcome can be favorable even in MRI-negative patients.
尽管手术切除是一种成熟的治疗方法，但在决定哪些额叶癫痫（FLE）患者应接受手术切除时仍存在争议。本研究的目的是定义多种结果衡量指标，并确定是否存在某些首选手术候选人群，这些人群具有更有利的癫痫预后。
58 例患者接受了额叶 FLE 切除术，平均随访时间为 79.3 个月（范围为 12-208 个月）。患者的人口统计学，临床发作特征，额叶内发作起始区以及诊断测试均进行了记录。使用 Engel 分级，国际抗癫痫联盟（ILAE）分级，术后发作模式，首次复发发作的时间以及最后一年的随访中的发作和就业情况作为结果衡量指标。神经心理学表现和贝克抑郁量表（BDI）评分用于定义神经心理学结果，并作为预测癫痫发作结果的指标进行检查。
33 例（57％）接受手术切除的患者有 Engel 分级 I 结果，29 例（50％）有 ILAE 分级 I 结果。术后首次发作的平均时间为 33.3 个月（范围为 0-208）。在整个随访期间，仅有 14 例患者（24％）无先兆完全无发作（Engel IA）。最常见的复发模式是混合性，有较长时间的无发作期和复发期。此外，32％的患者就业机会增加，52％的患者能够减少使用抗癫痫药物（AED），尽管只有 9％的患者停止使用 AED。未发现 I 级或 IA 级结果与存在局灶性磁共振成像（MRI）异常，额叶内任何特定的发作灶定位或神经心理学变化之间存在显著相关性。
研究结果表明，FLE 切除术的长期结果通常是有利的，并且支持需要考虑多种结果衡量指标来更全面地描述临床相关的术后变化。即使在 MRI 阴性的患者中，结果也可能是有利的。
