Bonilha Leonardo, Keller Simon S
1 Department of Neurology and Neurosurgery, Medical University of South Carolina, Charleston, SC 29425, USA ; 2 Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK ; 3 Department of Radiology, The Walton Centre NHS Foundation Trust, Liverpool, UK ; 4 Department of Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
Quant Imaging Med Surg. 2015 Apr;5(2):204-24. doi: 10.3978/j.issn.2223-4292.2015.01.01.
Medically intractable temporal lobe epilepsy (TLE) remains a serious health problem. Across treatment centers, up to 40% of patients with TLE will continue to experience persistent postoperative seizures at 2-year follow-up. It is unknown why such a large number of patients continue to experience seizures despite being suitable candidates for resective surgery. Preoperative quantitative MRI techniques may provide useful information on why some patients continue to experience disabling seizures, and may have the potential to develop prognostic markers of surgical outcome. In this article, we provide an overview of how quantitative MRI morphometric and diffusion tensor imaging (DTI) data have improved the understanding of brain structural alterations in patients with refractory TLE. We subsequently review the studies that have applied quantitative structural imaging techniques to identify the neuroanatomical factors that are most strongly related to a poor postoperative prognosis. In summary, quantitative imaging studies strongly suggest that TLE is a disorder affecting a network of neurobiological systems, characterized by multiple and inter-related limbic and extra-limbic network abnormalities. The relationship between brain alterations and postoperative outcome are less consistent, but there is emerging evidence suggesting that seizures are less likely to remit with surgery when presurgical abnormalities are observed in the connectivity supporting brain regions serving as network nodes located outside the resected temporal lobe. Future work, possibly harnessing the potential from multimodal imaging approaches, may further elucidate the etiology of persistent postoperative seizures in patients with refractory TLE. Furthermore, quantitative imaging techniques may be explored to provide individualized measures of postoperative seizure freedom outcome.
药物难治性颞叶癫痫（TLE）仍然是一个严重的健康问题。在各个治疗中心，高达40%的TLE患者在术后2年随访时仍会持续出现癫痫发作。尽管大量患者是切除性手术的合适人选，但仍有癫痫发作，原因尚不清楚。术前定量MRI技术可能为一些患者仍有致残性癫痫发作的原因提供有用信息，并有可能开发手术结果的预后标志物。在本文中，我们概述了定量MRI形态学和扩散张量成像（DTI）数据如何增进了对难治性TLE患者脑结构改变的理解。随后，我们回顾了应用定量结构成像技术来识别与术后预后不良最密切相关的神经解剖学因素的研究。总之，定量成像研究强烈表明，TLE是一种影响神经生物学系统网络的疾病，其特征是多个相互关联的边缘系统和边缘外系统网络异常。脑改变与术后结果之间的关系不太一致，但有新证据表明，当在位于切除颞叶之外的作为网络节点的支持脑区的连接性中观察到术前异常时，手术缓解癫痫发作的可能性较小。未来的工作，可能利用多模态成像方法的潜力，可能会进一步阐明难治性TLE患者术后持续癫痫发作的病因。此外，可以探索定量成像技术以提供术后癫痫发作自由结果的个体化测量。
