Radhakrishnan Ashalatha, Menon Ramshekhar, Menon Deepak, Singh Atampreet, Radhakrishnan Neelima, Vilanilam George, Abraham Mathew, Thomas Bejoy, Kesavadas Chandrashekharan, Varma Ravi Prasad, Thomas Sanjeev V
R. Madhavan Nayar Centre for Comprehensive Epilepsy Care, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India.
R. Madhavan Nayar Centre for Comprehensive Epilepsy Care, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India.
Epilepsy Res. 2016 Aug;124:1-11. doi: 10.1016/j.eplepsyres.2016.04.006. Epub 2016 Apr 30.
We analyzed consecutive cases of a large cohort of the spectrum of malformations of cortical development (MCDs) including focal cortical dysplasias (FCDs) who underwent presurgical evaluation through our epilepsy program from January 2000-December 2010. We analyzed factors predicting surgical candidacy, predictors of seizure outcome and reasons for deferring surgery.
148 patients with MCD underwent detailed presurgical evaluation and 69 were operated. MCD was diagnosed based on characteristic findings in MRI and re-confirmation by histopathology in operated patients. Post-operative seizure outcome of non-operated and operated patients were assessed every 3 and 12 months and yearly intervals. Multivariate analysis and backward step-wise logistic regression analyzed factors predicting seizure outcome. Kaplan-Meier analysis predicted seizure-free survival rates.
66.67% patients were seizure-free and aura-free at last follow-up. On multivariate logistic regression, the predictors of seizure freedom in operated MCDs were completeness of resection (odds ratio 8.2; 95% CI 1.43-64.96, p=0.01), shorter duration of epilepsy (odds ratio 1.19, 95% CI 1.02-1.39, p=0.02), and absence of spikes in post-operative EEG at one year (odds ratio 4.2; 95% CI 2.52-16.6; p<0.002). In FCD sub-group, shorter duration of epilepsy (11.1 versus 16.1 years, p=0.03), absence of secondary generalized seizures (p=0.05), absence of spikes in post-operative EEG on seventh day (p=0.009) and one year (p=0.002) were associated with favorable seizure outcome.
Majority of patients with MCD and refractory epilepsy when operated early remains seizure-free. Shorter duration of epilepsy is the single most important pre-operative variable and absence of spikes in post-operative EEG, predicts a long-term favorable seizure outcome.
我们分析了一大群皮质发育畸形（MCDs）患者的连续病例，包括局灶性皮质发育不良（FCDs），这些患者在2000年1月至2010年12月期间通过我们的癫痫项目接受了术前评估。我们分析了预测手术候选资格的因素、癫痫发作结果的预测因素以及推迟手术的原因。
148例MCD患者接受了详细的术前评估，其中69例接受了手术。MCD根据MRI的特征性表现进行诊断，并在手术患者中通过组织病理学进行再次确认。未手术和手术患者的术后癫痫发作结果每3个月、12个月和每年进行评估。多变量分析和向后逐步逻辑回归分析了预测癫痫发作结果的因素。Kaplan-Meier分析预测了无癫痫发作生存率。
在最后一次随访时，66.67%的患者无癫痫发作且无先兆。在多变量逻辑回归中，手术治疗的MCD患者癫痫发作缓解的预测因素包括切除的完整性（比值比8.2；95%可信区间1.43-64.96，p=0.01）、癫痫病程较短（比值比1.19，95%可信区间1.02-1.39，p=0.02）以及术后1年脑电图无棘波（比值比4.2；95%可信区间2.52-16.6；p<0.002）。在FCD亚组中，癫痫病程较短（11.1年对16.1年，p=0.03）、无继发性全面性发作（p=0.05）、术后第7天（p=0.009）和1年脑电图无棘波（p=0.002）与良好的癫痫发作结果相关。
大多数MCD和难治性癫痫患者早期手术治疗后仍无癫痫发作。癫痫病程较短是最重要的术前变量，术后脑电图无棘波预示着长期良好的癫痫发作结果。
