Carreño Mar, Bien Christian G, Asadi-Pooya Ali A, Sperling Michael, Marusic Petr, Elisak Martin, Pimentel Jose, Wehner Tim, Mohanraj Rajiv, Uranga Juan, Gómez-Ibáñez Asier, Villanueva Vicente, Gil Francisco, Donaire Antonio, Bargalló Nuria, Rumià Jordi, Roldán Pedro, Setoain Xavier, Pintor Luis, Boget Teresa, Bailles Eva, Falip Mercè, Aparicio Javier, Dalmau Josep, Graus Francesc
Epilepsy Unit, Department of Neurology, Hospital Clínic, Barcelona, Spain.
Epilepsy Center Bethel, Krankenhaus Mara, Bielefeld, Germany.
Epilepsy Res. 2017 Jan;129:101-105. doi: 10.1016/j.eplepsyres.2016.12.010. Epub 2016 Dec 15.
We assessed the outcome of patients with drug resistant epilepsy and neuronal antibodies who underwent epilepsy surgery. Retrospective study, information collected with a questionnaire sent to epilepsy surgery centers. Thirteen patients identified, with antibodies to GAD (8), Ma2 (2), Hu (1), LGI1 (1) or CASPR2 (1). Mean age at seizure onset: 23 years. Five patients had an encephalitic phase. Three had testicular tumors and five had autoimmune diseases. All had drug resistant temporal lobe epilepsy (median: 20 seizures/month). MRI showed unilateral temporal lobe abnormalities (mainly hippocampal sclerosis) in 9 patients, bilateral abnormalities in 3, and was normal in 1. Surgical procedures included anteromesial temporal lobectomy (10 patients), selective amygdalohippocampectomy (1), temporal pole resection (1) and radiofrequency ablation of mesial structures (1). Perivascular lymphocytic infiltrates were seen in 7/12 patients. One year outcome available in all patients, at 3 years in 9. At last visit 5/13 patients (38.5%) (with Ma2, Hu, LGI1, and 2 GAD antibodies) were in Engel's classes I or II. Epilepsy surgery may be an option for patients with drug resistant seizures associated with neuronal antibodies. Outcome seems to be worse than that expected in other etiologies, even in the presence of unilateral HS. Intracranial EEG may be required in some patients.
我们评估了接受癫痫手术的耐药性癫痫和神经元抗体患者的预后。回顾性研究，通过向癫痫手术中心发送问卷收集信息。共确定了13例患者，分别有抗GAD抗体（8例）、抗Ma2抗体（2例）、抗Hu抗体（1例）、抗LGI1抗体（1例）或抗CASPR2抗体（1例）。癫痫发作起始的平均年龄为23岁。5例患者有脑炎期。3例有睾丸肿瘤，5例有自身免疫性疾病。所有患者均为耐药性颞叶癫痫（中位数：每月20次发作）。MRI显示9例患者单侧颞叶异常（主要为海马硬化），3例双侧异常，1例正常。手术方式包括前内侧颞叶切除术（10例）、选择性杏仁核海马切除术（1例）、颞极切除术（1例）和内侧结构射频消融术（1例）。12例患者中有7例可见血管周围淋巴细胞浸润。所有患者均有1年的预后数据，9例有3年的预后数据。在最后一次随访时，13例患者中有5例（38.5%）（有抗Ma2、抗Hu、抗LGI1抗体以及2例抗GAD抗体）处于恩格尔分级的I级或II级。对于伴有神经元抗体的耐药性癫痫发作患者，癫痫手术可能是一种选择。即使存在单侧海马硬化，其预后似乎也比其他病因预期的要差。部分患者可能需要进行颅内脑电图检查。
