Division of Epilepsy, Department of Neurology, Mayo Clinic, Rochester, Minnesota.
JAMA Neurol. 2016 Apr;73(4):464-70. doi: 10.1001/jamaneurol.2015.4996.
Surgery is an effective treatment for drug-resistant focal epilepsy. Neuroimaging studies are considered essential in the diagnostic evaluation of individuals with medically refractory focal seizures being considered for surgical treatment.
To review the evidence for the use of neuroimaging studies in the selection of patients with drug-resistant temporal lobe epilepsy for focal cortical resection and discuss the prognostic importance of selected techniques.
Randomized clinical trials, meta-analyses, and clinical retrospective case studies (≥20 patients with ≥1 year of follow-up) were identified using Medical Subject Headings and indexed text terms in EMBASE (1988-November 29, 2014); MEDLINE (1946-December 2, 2014), Cochrane Central Register of Controlled Trials (1991-October 31, 2014), and Cochrane Database of Systematic Reviews (2005-October 31, 2014). Twenty-seven articles describing 3163 patients were included. Neuroimaging techniques analyzed included magnetic resonance imaging (MRI), positron emission tomography (PET), and single-photon emission computed tomography (SPECT). Subpopulations and prognostic factors were identified.
Of the 27 studies evaluated (3163 patients), 7 showed the outcome was more favorable in patients with MRI-identified hippocampal atrophy indicating mesial temporal sclerosis. Five additional studies indicated that the outcome was less favorable in patients with unremarkable MRI studies. There are conflicting findings regarding the prognostic importance of PET-identified focal hypometabolism; however, 2 investigations indicated that the presence of a PET imaging study demonstrating abnormalities in individuals with unremarkable MRI results showed an operative outcome similar to that in patients with mesial temporal sclerosis. The studies assessing SPECT use in temporal lobe epilepsy did not reveal a correlation with outcome.
There is strong evidence that preoperative MRI-identified hippocampal atrophy consistent with mesial temporal sclerosis concordant with the seizure origin in the temporal lobe is a significant factor associated with a favorable outcome. PET studies may be valuable in individuals with unremarkable MRI findings. The current evidence does not support the prognostic importance of SPECT in patients undergoing temporal lobe surgery.
手术是治疗耐药性局灶性癫痫的有效方法。神经影像学研究被认为是对考虑手术治疗的药物难治性局灶性癫痫患者进行诊断评估的重要手段。
综述神经影像学研究在选择药物难治性颞叶癫痫患者进行皮质切除术的应用，并讨论所选技术的预后意义。
使用 Medical Subject Headings 和 EMBASE（1988 年 11 月 29 日至 2014 年）中的索引文本词、MEDLINE（1946 年 12 月 2 日至 2014 年）、Cochrane 对照试验中心注册库（1991 年 10 月 31 日至 2014 年）和 Cochrane 系统评价数据库（2005 年 10 月 31 日至 2014 年）检索随机临床试验、荟萃分析和临床回顾性病例研究（≥20 例患者，随访时间≥1 年）。共纳入 27 篇文章，涉及 3163 例患者。分析的神经影像学技术包括磁共振成像（MRI）、正电子发射断层扫描（PET）和单光子发射计算机断层扫描（SPECT）。确定了亚人群和预后因素。
在评估的 27 项研究（3163 例患者）中，有 7 项研究表明，MRI 显示海马萎缩提示内侧颞叶硬化的患者预后更好。另外 5 项研究表明，MRI 检查无异常的患者预后较差。PET 显示局灶性低代谢的预后意义存在争议；然而，有 2 项研究表明，PET 成像研究显示 MRI 结果正常的患者存在异常，其手术结果与内侧颞叶硬化患者相似。评估 SPECT 在颞叶癫痫中的应用的研究未显示与结果的相关性。
有强有力的证据表明，术前 MRI 显示与颞叶起源一致的海马萎缩，符合内侧颞叶硬化，是与良好预后相关的重要因素。MRI 检查无异常的患者 PET 检查可能有价值。目前的证据不支持 SPECT 在颞叶手术患者中的预后意义。
