Adry Rodrigo Antonio Rocha da Cruz, Meguins Lucas Crociati, da Silva Júnior Sebastião Carlos, Pereira Carlos Umberto, de Araújo Filho Gerardo Maria, Marques Lúcia Helena Neves
Neurosurgery. Department of Neurological Sciences, Hospital de Base de São José do Rio Preto-Faculty of Medicine at São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil.
Hospital Aliança, Salvador, Bahia, Brazil.
Acta Neurochir (Wien). 2016 Dec;158(12):2355-2363. doi: 10.1007/s00701-016-2992-0. Epub 2016 Oct 21.
Mesial temporal sclerosis (MTS) is the most common disease found in an epilepsy surgery series. Early age of onset, a history of febrile convulsions, epileptiform discharges on EEG, duration of epilepsy, number of generalized seizures and severity of psychiatric disorders are possible prognostic factors in patients with MTS.
The aim of this study is to review the clinical, semiotic, psychological, electrophysiological and neuroradiological researches and relate their findings to the prognosis of patients with MTS who underwent anteromedial temporal lobectomy (ATL).
Of 1,214 patients evaluated for surgery in the epilepsy Center of Faculdade de Medicina de São Jose do Rio Preto (FAMERP), a tertiary Brazilian epilepsy center, 400 underwent ATL for MTS. Examinations and clinical data were analyzed and compared with the Engel Outcome Classification.
Of all the items analyzed, the MRI showed the greatest influence on patient outcome. As for the clinical evaluation and pathological antecedents, age at surgery, epilepsy duration, perinatal insults, family history of epilepsy, febrile seizures, neuropsychological abnormalities and presence of generalized tonic-clonic seizure all had statistical significance.
In order to identify the most appropriate candidates for ATL, it is very important to consider the prognostic factors associated with a favorable outcome for counseling patients in daily practice.
内侧颞叶硬化（MTS）是癫痫手术系列中最常见的疾病。发病年龄早、热性惊厥病史、脑电图上的癫痫样放电、癫痫持续时间、全身性发作次数以及精神障碍的严重程度可能是MTS患者的预后因素。
本研究旨在回顾临床、症状学、心理学、电生理学和神经放射学研究，并将其结果与接受前内侧颞叶切除术（ATL）的MTS患者的预后相关联。
在巴西三级癫痫中心圣若泽杜里奥普雷图医学院（FAMERP）癫痫中心接受手术评估的1214例患者中，400例因MTS接受了ATL。对检查和临床数据进行分析，并与恩格尔结果分类进行比较。
在所有分析的项目中，MRI对患者预后的影响最大。至于临床评估和病理病史，手术年龄、癫痫持续时间、围产期损伤、癫痫家族史、热性惊厥、神经心理异常以及全身性强直阵挛发作的存在均具有统计学意义。
为了确定最适合接受ATL的患者，在日常实践中为患者提供咨询时，考虑与良好预后相关的预后因素非常重要。
