UCL Institute of Neurology, UCL, London, UK Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy Jules Thorne Telemetry Unit, National Hospital for Neurology and Neurosurgery, London, UK.
UCL Institute of Neurology, UCL, London, UK Jules Thorne Telemetry Unit, National Hospital for Neurology and Neurosurgery, London, UK Department of Neurology, University of Muenster, Muenster, Germany.
J Neurol Neurosurg Psychiatry. 2016 Feb;87(2):209-11. doi: 10.1136/jnnp-2014-310148. Epub 2015 May 2.
To define factors that predict whether patients with pharmacoresistant focal epilepsy are offered epilepsy surgery (including invasive EEG) and the main reasons for not proceeding with these after non-invasive presurgical evaluation.
We retrospectively analysed data from 612 consecutive patients with focal epilepsy admitted to a video-EEG Telemetry Unit for presurgical evaluation, and used a multivariate logistic regression model to assess the predictive value of factors for being offered potentially curative surgery.
In the multivariate analysis, bilateral lesions on MRI (OR: 0.10; 95% CI 0.03 to 0.24), no lesion (OR: 0.33; 95% CI 0.22 to 0.49) or extratemporal lobe epilepsy (OR: 0.30; 95% CI 0.20 to 0.45) were the only factors that significantly reduced the probability of being offered surgery. 32% of patients who were offered epilepsy surgery decided against proceeding.
There was a low chance (<10%) of being offered surgery if there were bilateral lesions on MRI and extratemporal lobe epilepsy. Patients should be given advice on the risk/benefit ratio and of realistic outcomes of epilepsy surgery; this may help reduce the number of patients who refuse surgery after comprehensive workup.
确定预测药物难治性局灶性癫痫患者是否接受癫痫手术（包括侵入性脑电图）的因素，以及在非侵入性术前评估后不进行这些手术的主要原因。
我们回顾性分析了 612 例因术前评估而入住视频脑电图遥测单元的局灶性癫痫连续患者的数据，并使用多变量逻辑回归模型评估了对可能治愈性手术进行预测的因素的预测价值。
在多变量分析中，MRI 上双侧病变（OR：0.10；95%CI 0.03 至 0.24）、无病变（OR：0.33；95%CI 0.22 至 0.49）或颞外癫痫（OR：0.30；95%CI 0.20 至 0.45）是唯一显著降低手术可能性的因素。32%被提议接受癫痫手术的患者决定不继续手术。
如果 MRI 上有双侧病变和颞外癫痫，接受手术的机会就很小（<10%）。应向患者提供有关手术风险/获益比和癫痫手术实际结果的建议；这可能有助于减少全面检查后拒绝手术的患者数量。
