Department of Neurology, Medical College of Georgia, Georgia Health Sciences University, Augusta, GA 30912, USA.
Seizure. 2012 Nov;21(9):722-8. doi: 10.1016/j.seizure.2012.07.017. Epub 2012 Aug 15.
To identify predictors of seizure recurrence following posterior quadrant epilepsy surgery.
Between 1983 and 2008, 43 medically refractory epilepsy patients underwent posterior quadrant epilepsy surgery. Epilepsy surgery involved the occipital lobe in all cases; some cases also included resection of the adjacent parietal or temporal cortex. Using a logistic regression model, we evaluated the relationship between outcome (Engel class I-IV) and 5 outcome predictors: absence of a visual aura, a temporal lobe type aura, versive head movement unaccompanied by a visual aura, non-focal interictal scalp EEG, and surgical pathology other than low grade tumor or cortical dysplasia. We also determined the relative risk for significant post-operative cognitive decline of Wechsler intelligence test score among those receiving complete lobectomies compared to those receiving partial lobectomies.
Overall, outcome was favorable at 1 year following surgery: 22 (51.2%) patients Engel class I, 10 (24%) patients Engel class II, 5 (12%) patients Engel class III, and 6 (14%) patients Engel class IV. The 3 best univariate predictors of seizure recurrence were versive head movement unaccompanied by visual aura, non-focal interictal scalp EEG, and pathology other than low grade tumor or cortical dysplasia. A multivariate predictor combining temporal lobe type aura, versive head movement unaccompanied by visual aura, non-focal interictal scalp EEG, and pathology other than low grade tumor or cortical dysplasia was optimum. Complete lobectomy significantly increased the risk of post-operative decline of Wechsler intelligence score.
These findings indicate that posterior quadrant epilepsy surgery may provide sustained seizure control. A multivariate model combining temporal lobe type aura, versive head movement unaccompanied by a visual aura, non-focal interictal scalp EEG, and pathology other than low grade tumor or cortical dysplasia may contribute to predicting seizure recurrence following posterior quadrant epilepsy surgery. The extent of cortical resection may predict significant cognitive decline in post-operative Wechsler intelligence score.
确定后部象限癫痫手术后癫痫复发的预测因素。
1983 年至 2008 年间，43 例药物难治性癫痫患者接受了后部象限癫痫手术。所有病例均涉及枕叶手术；部分病例还包括切除相邻的顶叶或颞叶皮质。我们使用逻辑回归模型，评估了结局（Engel 分级 I-IV）与 5 个结局预测因素之间的关系：无视觉先兆、颞叶型先兆、无视觉先兆的扭转性头动、非局灶性发作间期头皮脑电图和除低级肿瘤或皮质发育不良以外的手术病理。我们还确定了接受完全叶切除术与接受部分叶切除术的患者之间威氏智力测验评分术后认知功能显著下降的相对风险。
总体而言，术后 1 年的结局良好：22 例（51.2%）患者为 Engel 分级 I，10 例（24%）患者为 Engel 分级 II，5 例（12%）患者为 Engel 分级 III，6 例（14%）患者为 Engel 分级 IV。3 个预测癫痫复发的最佳单变量预测因素是无视觉先兆的扭转性头动、非局灶性发作间期头皮脑电图和除低级肿瘤或皮质发育不良以外的病理。一个结合颞叶型先兆、无视觉先兆的扭转性头动、非局灶性发作间期头皮脑电图和除低级肿瘤或皮质发育不良以外的病理的多变量预测因素是最佳的。完全叶切除术显著增加了术后威氏智力测验评分下降的风险。
这些发现表明，后部象限癫痫手术可能提供持续的癫痫控制。一个结合颞叶型先兆、无视觉先兆的扭转性头动、非局灶性发作间期头皮脑电图和除低级肿瘤或皮质发育不良以外的病理的多变量模型可能有助于预测后部象限癫痫手术后的癫痫复发。皮质切除术的范围可能预测术后威氏智力测验评分的显著认知下降。
