Harroud Adil, Bouthillier Alain, Weil Alexander G, Nguyen Dang Khoa
Division of Neurology, Hôpital Notre-Dame du CHUM, University of Montreal, Montreal, QC, Canada H2L 4M1.
Epilepsy Res Treat. 2012;2012:201651. doi: 10.1155/2012/201651. Epub 2012 Apr 22.
Patients with temporal lobe epilepsy (TLE) are refractory to antiepileptic drugs in about 30% of cases. Surgical treatment has been shown to be beneficial for the selected patients but fails to provide a seizure-free outcome in 20-30% of TLE patients. Several reasons have been identified to explain these surgical failures. This paper will address the five most common causes of TLE surgery failure (a) insufficient resection of epileptogenic mesial temporal structures, (b) relapse on the contralateral mesial temporal lobe, (c) lateral temporal neocortical epilepsy, (d) coexistence of mesial temporal sclerosis and a neocortical lesion (dual pathology); and (e) extratemporal lobe epilepsy mimicking TLE or temporal plus epilepsy. Persistence of epileptogenic mesial structures in the posterior temporal region and failure to distinguish mesial and lateral temporal epilepsy are possible causes of seizure persistence after TLE surgery. In cases of dual pathology, failure to identify a subtle mesial temporal sclerosis or regions of cortical microdysgenesis is a likely explanation for some surgical failures. Extratemporal epilepsy syndromes masquerading as or coexistent with TLE result in incomplete resection of the epileptogenic zone and seizure relapse after surgery. In particular, the insula may be an important cause of surgical failure in patients with TLE.
约30%的颞叶癫痫（TLE）患者对抗癫痫药物难治。手术治疗已被证明对部分选定患者有益，但仍有20%-30%的TLE患者术后未实现无癫痫发作。已确定了几个原因来解释这些手术失败情况。本文将阐述TLE手术失败的五个最常见原因：（a）致痫性颞叶内侧结构切除不充分；（b）对侧颞叶内侧复发；（c）颞叶外侧新皮质癫痫；（d）颞叶内侧硬化与新皮质病变并存（双重病理）；以及（e）模仿TLE的颞叶外癫痫或颞叶加癫痫。颞叶后部区域致痫性颞叶内侧结构持续存在以及未能区分颞叶内侧和外侧癫痫，可能是TLE手术后癫痫持续发作的原因。在双重病理的情况下，未能识别细微的颞叶内侧硬化或皮质微发育异常区域可能是一些手术失败的原因。伪装成TLE或与TLE并存的颞叶外癫痫综合征会导致致痫区切除不完全，术后癫痫复发。特别是，岛叶可能是TLE患者手术失败的一个重要原因。
