Department of Neurology, Mayo Clinic, Scottsdale, Arizona, USA.
JAMA Neurol. 2013 Aug;70(8):1003-8. doi: 10.1001/jamaneurol.2013.209.
A focal lesion detected by use of magnetic resonance imaging (MRI) is a favorable prognostic finding for epilepsy surgery. Patients with normal MRI findings and extratemporal lobe epilepsy have less favorable outcomes. Most studies investigating the outcomes of patients with normal MRI findings who underwent (nonlesional) extratemporal epilepsy surgery are confined to a highly select group of patients with limited follow-up.
To evaluate noninvasive diagnostic test results and their association with excellent surgical outcomes (defined using Engel classes I-IIA of surgical outcomes) in a group of patients with medically resistant nonlesional extratemporal epilepsy.
A retrospective study.
Mayo Clinic, Rochester, Minnesota.
From 1997 through 2002, we identified 85 patients with medically resistant extratemporal lobe epilepsy who had normal MRI findings. Based on a standardized presurgical evaluation and review at a multidisciplinary epilepsy surgery conference, some of these patients were selected for intracranial electroencephalographic (EEG) monitoring and epilepsy surgery.
Nonlesional extratemporal lobe epilepsy surgery.
The results of noninvasive diagnostic tests and the clinical variables potentially associated with excellent surgical outcome were examined in patients with a minimum follow-up of 1 year (mean follow-up, 9 years).
Based on the noninvasive diagnostic test results, a clear hypothesis for seizure origin was possible for 47 of the 85 patients (55%), and 31 of these 47 patients (66%) proceeded to intracranial EEG monitoring. For 24 of these 31 patients undergoing long-term intracranial EEG (77%), a seizure focus was identified and surgically resected. Of these 24 patients, 9 (38%) had an excellent outcome after resective epilepsy surgery. All patients with an excellent surgical outcome had at least 10 years of follow-up. Univariate analysis showed that localized interictal epileptiform discharges on scalp EEGs were associated with an excellent surgical outcome.
Scalp EEG was the most useful test for identifying patients with normal MRI findings and extratemporal lobe epilepsy who were likely to have excellent outcomes after epilepsy surgery. Extending outcome analysis beyond the resective surgery group to the entire group of patients who were evaluated further highlights the challenge that these patients pose. Although 9 of 24 patients undergoing resective surgery (38%) had excellent outcomes, only 9 of 31 patients undergoing intracranial EEG (29%) and only 9 of 85 patient with nonlesional extratemporal lobe epilepsy (11%) had long-term excellent outcomes.
磁共振成像（MRI）检测到的局灶性病变是癫痫手术的有利预后发现。MRI 检查正常且患有颞叶外癫痫的患者预后较差。大多数研究都集中在一组经过（无病变）颞叶外癫痫手术的高度选择患者，随访时间有限。
评估一组药物难治性非病变性颞叶外癫痫患者的非侵入性诊断测试结果及其与优秀手术结果（定义为手术结果的 Engel 分类 I-IIA）的相关性。
回顾性研究。
明尼苏达州罗切斯特市梅奥诊所。
1997 年至 2002 年间，我们确定了 85 名药物难治性颞叶外癫痫患者，其 MRI 检查结果正常。根据标准化的术前评估和多学科癫痫手术会议的回顾，其中一些患者被选择进行颅内脑电图（EEG）监测和癫痫手术。
非病变性颞叶外癫痫手术。
对至少随访 1 年（平均随访时间 9 年）的患者进行非侵入性诊断测试结果和可能与优秀手术结果相关的临床变量进行检查。
根据非侵入性诊断测试结果，47 名患者（55%）可能对癫痫发作起源有明确的假设，其中 31 名患者（66%）进行了颅内 EEG 监测。在这 31 名接受长期颅内 EEG 的患者中，24 名患者（77%）确定了癫痫发作灶并进行了手术切除。在这 24 名患者中，9 名（38%）在接受切除性癫痫手术后有良好的结局。所有具有良好手术结局的患者均有至少 10 年的随访。单因素分析显示，头皮 EEG 上局灶性发作间癫痫样放电与良好的手术结局相关。
头皮 EEG 是最有用的测试方法，可用于识别 MRI 检查正常且患有颞叶外癫痫的患者，这些患者在癫痫手术后很可能有良好的结局。将手术结果分析从切除手术组扩展到进一步评估的所有患者组进一步突出了这些患者带来的挑战。虽然接受切除性手术的 24 名患者中有 9 名（38%）有良好的结局，但接受颅内 EEG 的 31 名患者中有 9 名（29%），以及接受非病变性颞叶外癫痫的 85 名患者中有 9 名（11%）有长期良好的结局。
