Capraz Irem Yıldırım, Kurt Gökhan, Akdemir Özgür, Hirfanoglu Tugba, Oner Yusuf, Sengezer Tugba, Kapucu Lütfiye Ozlem Atay, Serdaroglu Ayse, Bilir Erhan
Gazi University, Faculty of Medicine, Department of Neurology, Ankara, Turkey.
Gazi University, Faculty of Medicine, Department of Neurosurgery, Ankara, Turkey.
Seizure. 2015 Jul;29:63-8. doi: 10.1016/j.seizure.2015.03.015. Epub 2015 Mar 30.
The purpose of this study was to determine the long-term surgical outcomes of magnetic resonance imaging (MRI)-negative, fluorodeoxyglucose positron emission tomography (FDG-PET)-positive patients with temporal lobe epilepsy (TLE) and compare them with those of patients with mesial temporal sclerosis (MTS).
One hundred forty-one patients with TLE who underwent anterior temporal lobectomy were included in the study. The surgical outcomes of 24 patients with unilateral temporal hypometabolism on FDG-PET without an epileptogenic lesion on MRI were compared with that of patients with unilateral temporal hypometabolism on FDG-PET with MTS on MRI (n=117). The outcomes were compared using Engel's classification at 2 years after surgery. Clinical characteristics, unilateral interictal epileptiform discharges (IEDs), histopathological data and operation side were considered as probable prognostic factors.
Class I surgical outcomes were similar in MRI-negative patients and the patients with MTS on MRI (seizure-free rate at postoperative 2 years was 79.2% and 82% in the MRI-negative and MTS groups, respectively). In univariate analysis, history of febrile convulsions, presence of unilateral IEDs and left temporal localization were found to be significantly associated with seizure free outcome. Multivariate analysis revealed that independent predictors of a good outcome were history of febrile convulsions and presence of unilateral IEDs.
Our results suggest that epilepsy surgery outcomes of MRI-negative, PET positive patients are similar to those of patients with MTS. This finding may aid in the selection of best candidates for epilepsy surgery.
本研究旨在确定磁共振成像（MRI）阴性、氟脱氧葡萄糖正电子发射断层扫描（FDG-PET）阳性的颞叶癫痫（TLE）患者的长期手术效果，并将其与内侧颞叶硬化（MTS）患者的手术效果进行比较。
本研究纳入了141例行前颞叶切除术的TLE患者。将24例FDG-PET显示单侧颞叶代谢减低但MRI无致痫灶的患者的手术效果与117例FDG-PET显示单侧颞叶代谢减低且MRI有MTS的患者的手术效果进行比较。术后2年采用恩格尔分类法比较手术效果。临床特征、单侧发作间期癫痫样放电（IEDs）、组织病理学数据和手术侧别被视为可能的预后因素。
MRI阴性患者和MRI有MTS的患者的I级手术效果相似（MRI阴性组和MTS组术后2年无癫痫发作率分别为79.2%和82%）。单因素分析发现，热性惊厥病史、单侧IEDs的存在和左侧颞叶定位与无癫痫发作结局显著相关。多因素分析显示，良好结局的独立预测因素是热性惊厥病史和单侧IEDs的存在。
我们的结果表明，MRI阴性、PET阳性患者的癫痫手术效果与MTS患者相似。这一发现可能有助于选择癫痫手术的最佳候选者。
