Epileptology, University Hospital Bonn, Bonn, Germany.
Eur J Neurol. 2014 Jun;21(6):827-34. doi: 10.1111/ene.12322. Epub 2013 Dec 7.
In the epilepsy community, there is talk that the number of classical patients with early onset temporal lobe epilepsy (TLE) and Ammon's horn sclerosis (AHS) is decreasing. This is counterintuitive, considering the success story of epilepsy surgery, improved diagnostic methods and the current recommendation of early admission to surgery. In order to recognize trends, the development of temporal lobe surgery over 20 years in three major German epilepsy centers was reviewed.
Age at surgery and duration of epilepsy, which was differentiated according to histopathology (AHS, developmental, tumor, vascular), year of surgery and center, were evaluated in a cohort of 2812 patients from three German epilepsy centers who underwent temporal lobe surgery between 1988 and 2008. The analysis was carried out for the pooled cohort as well as for each center separately.
Of all patients, 52% showed AHS. Compared with other pathologies, the AHS group had the earliest epilepsy onset and the longest duration of epilepsy. Across five time epochs, the diagnosis of AHS increased in the first epoch, remaining constant thereafter. Contrary to the trends in other pathologies, in the AHS group the mean age of patients at surgery increased by 7 years and the duration of epilepsy until surgery increased by 5 years. This trend could be replicated in all three centers. As initially hypothesized for all groups, age and duration of epilepsy in other pathology groups remained constant or indicated earlier submission to surgery.
During the first few years studied, most probably due to progress in brain imaging, the proportion of patients with AHS increased. However, despite stable numbers over time, and contrary to the trends in other pathology groups, age and duration of epilepsy in mesial TLE with AHS (mTLE + AHS) increased over time. This supports the hypothesis of a decreasing incidence of AHS. This trend is discussed with respect to disease-modifying factors which have changed the incidence of classical mTLE + AHS or, alternatively, to recent developments in antiepileptic drug treatment, the appraisal of surgery and economic incentives for treatment options other than surgery.
在癫痫领域，有一种说法认为，早期发病的颞叶癫痫（TLE）和角回硬化（AHS）的经典患者数量正在减少。考虑到癫痫手术的成功案例、改进的诊断方法以及目前推荐尽早接受手术治疗，这种说法有违直觉。为了识别趋势，对三家德国癫痫中心 20 多年的颞叶手术发展情况进行了回顾。
对 1988 年至 2008 年间在三家德国癫痫中心接受颞叶手术的 2812 例患者的队列，根据组织病理学（AHS、发育性、肿瘤、血管）进行了手术时年龄和癫痫持续时间的评估，该持续时间根据手术年份和中心进行了区分。分析对汇总队列以及每个中心分别进行了分析。
在所有患者中，52%为 AHS。与其他病理类型相比，AHS 组的癫痫发作最早，癫痫持续时间最长。在五个时间阶段中，第一阶段 AHS 的诊断增加，此后保持不变。与其他病理类型的趋势相反，AHS 组的手术患者年龄平均增加了 7 岁，手术前的癫痫持续时间增加了 5 年。这一趋势在所有三个中心都得到了复制。与最初对所有组的假设一样，其他病理类型组的年龄和癫痫持续时间保持不变或表明更早地接受手术。
在研究的最初几年，可能是由于脑成像的进步，AHS 患者的比例增加。然而，尽管随着时间的推移数量保持稳定，但与其他病理类型组的趋势相反，AHS 伴内侧 TLE（mTLE+AHS）的年龄和癫痫持续时间随时间增加。这支持了 AHS 发病率降低的假说。讨论了这种趋势与改变经典 mTLE+AHS 发病率的疾病修饰因素有关，或者与抗癫痫药物治疗的最新进展、手术评估以及手术以外的治疗方案的经济激励有关。
