Arya Ravindra, Leach James L, Horn Paul S, Greiner Hansel M, Gelfand Michael, Byars Anna W, Arthur Todd M, Tenney Jeffrey R, Jain Sejal V, Rozhkov Leonid, Fujiwara Hisako, Rose Douglas F, Mangano Francesco T, Holland Katherine D
Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Seizure. 2016 Oct;41:56-61. doi: 10.1016/j.seizure.2016.07.004. Epub 2016 Jul 20.
Lack of a potentially epileptogenic lesion on brain magnetic resonance imaging (MRI) is a poor prognostic marker for epilepsy surgery. We present a single-center series of childhood-onset MRI-negative drug-resistant epilepsy (DRE) and analyze surgical outcomes and predictors.
Children with MRI-negative DRE who had resective surgery from January 2007 to December 2013 were identified using an institutional database. Relevant clinical, neurophysiological, imaging, and surgical data was extracted. The primary outcome measure was seizure freedom. Predictors of seizure freedom were obtained using multivariate logistic regression.
Out of 47 children with MRI-negative DRE, 12 (25.5%) were seizure free (International League Against Epilepsy [ILAE] outcome class I), after mean follow-up of 2.75 (±1.72) years. Seizure-free proportion was significantly higher in patients with single seizure semiology and concordant ictal EEG (50.0% vs. 15.2%, p=0.025). Multivariate analysis using only non-invasive pre-surgical data showed that children with daily seizures (OR 0.02, 95% CI<0.001-0.55), and earlier onset of seizures (OR 0.72, 95% CI 0.52-0.99) were less likely to be seizure-free. Also, each additional anti-epileptic drug (AED) tried before surgery decreased the probability of seizure-free outcome (OR 0.16, 95% CI 0.04-0.63). Repeat multivariate analysis after including surgical variables found no additional significant predictors of seizure-freedom. Cortical dysplasia (ILAE type IB) was the commonest histopathology.
Surgical outcomes in children with MRI-negative DRE are determined by clinical factors including seizure frequency, age of onset of seizures, and number of failed AEDs.
脑磁共振成像（MRI）上缺乏潜在致痫性病变是癫痫手术预后不良的标志。我们展示了一组单中心儿童期起病的MRI阴性药物难治性癫痫（DRE）病例系列，并分析手术结果及预测因素。
利用机构数据库确定2007年1月至2013年12月期间接受切除性手术的MRI阴性DRE患儿。提取相关临床、神经生理学、影像学和手术数据。主要结局指标是无癫痫发作。使用多因素逻辑回归分析无癫痫发作的预测因素。
47例MRI阴性DRE患儿中，平均随访2.75（±1.72）年后，12例（25.5%）无癫痫发作（国际抗癫痫联盟[ILAE]结局分类I级）。单一发作症状学和发作期脑电图一致的患者无癫痫发作比例显著更高（50.0%对15.2%，p = 0.025）。仅使用术前非侵入性数据进行的多因素分析显示，每日发作的儿童（比值比[OR]0.02，95%置信区间[CI]<0.001 - 0.55）和癫痫发作起病较早的儿童（OR 0.72，95% CI 0.52 - 0.99）无癫痫发作的可能性较小。此外，术前每多尝试一种抗癫痫药物（AED），无癫痫发作结局的概率就会降低（OR 0.16，95% CI 0.04 - 0.63）。纳入手术变量后进行的重复多因素分析未发现无癫痫发作的其他显著预测因素。皮质发育不良（ILAE 1B型）是最常见的组织病理学表现。
MRI阴性DRE患儿的手术结果由包括癫痫发作频率、发作起病年龄和失败的AED数量等临床因素决定。
