Martinoni Matteo, Berti Pier Paolo, Marucci Gianluca, Rubboli Guido, Volpi Lilia, Riguzzi Patrizia, Marliani Federica, Toni Francesco, Bisulli Francesca, Tinuper Paolo, Michelucci Roberto, Baruzzi Agostino, Giulioni Marco
IRCCS Institute of Neurological Science of Bologna, Division of Neurosurgery, Bellaria Hospital, Bologna, Italy.
IRCCS Institute of Neurological Science of Bologna, Division of Neurosurgery, Bellaria Hospital, Bologna, Italy.
World Neurosurg. 2016 Jun;90:448-453. doi: 10.1016/j.wneu.2016.02.072. Epub 2016 Mar 9.
Hippocampal sclerosis (HS) is the most common cause of drug-resistant medial temporal lobe epilepsy (MTLE). Structural abnormalities such as HS, granule cell pathology (GCP), and focal cortical dysplasia (FCD) have been classified histopathologically, possibly allowing a more accurate assessment of prognostic seizure and neuropsychologic outcomes. We correlated seizure outcome with comprehensive temporal lobe pathologic findings, identified according to the most recent classification systems of HS, GCP, and FCD.
All the 83 patients who underwent anterior temporal lobectomy (ATL) for drug-resistant MTLE and with a proven diagnosis of HS between April 2001 and May 2014 were collected. Patients were divided in 2 main groups: 1) isolated HS with/without GCP (HS +/- GCP); and 2) HS associated with FCD with/without GCP (HS+FCD +/- GCP). Patients were followed up at least 1 year, and seizure outcome was reported in accordance with Engel classification.
Group I: HS +/- GCP: Statistical analysis confirmed a better outcome in HS + GCP patients than in HS-no GCP (P < 0.05). Moreover, a better outcome for the patients affected by GCP type I was observed (P < 0.05). Group II: HS+FCD +/- GCP: Patients with HS variant type I presented a better seizure outcome than the patients with HS type II (Engel class IA HS type I vs. type II: 69% vs. 40%).
A pathology-based approach to epilepsy surgery might improve the interpretation of the results, could predict which cases will enjoy a better seizure outcome, and could help to the comprehension of the causes of failures.
海马硬化（HS）是药物难治性内侧颞叶癫痫（MTLE）最常见的病因。诸如HS、颗粒细胞病理改变（GCP）和局灶性皮质发育异常（FCD）等结构异常已通过组织病理学分类，这可能有助于更准确地评估癫痫发作的预后及神经心理学结果。我们将癫痫发作结果与根据HS、GCP和FCD的最新分类系统确定的颞叶综合病理结果进行了关联分析。
收集了2001年4月至2014年5月期间所有因药物难治性MTLE接受前颞叶切除术（ATL）且确诊为HS的83例患者。患者分为两个主要组：1）单纯HS伴/不伴GCP（HS±GCP）；2）HS合并FCD伴/不伴GCP（HS+FCD±GCP）。对患者进行至少1年的随访，并根据Engel分类报告癫痫发作结果。
第一组：HS±GCP：统计分析证实，HS+GCP患者的结果优于HS无GCP患者（P<0.05）。此外，观察到I型GCP患者的结果更好（P<0.05）。第二组：HS+FCD±GCP：I型HS变异患者的癫痫发作结果优于II型HS患者（Engel IA级，I型HS与II型HS：69%对40%）。
基于病理学的癫痫手术方法可能会改善对结果的解读，能够预测哪些病例的癫痫发作结果更好，并有助于理解手术失败的原因。
