Department of Neurology, Konkuk University School of Medicine, Seoul, Korea.
Department of Neurology, College of Medicine, Seoul National University Hospital, Seoul, Korea.
JAMA Neurol. 2017 Mar 1;74(3):324-331. doi: 10.1001/jamaneurol.2016.4439.
The proportion of surgery for nonlesional neocortical epilepsy has recently increased, with a decrease in surgery for mesial temporal lobe epilepsy. However, there are only a few studies regarding the long-term surgical outcome and the potential prognostic factors for patients with nonlesional neocortical epilepsy.
To evaluate the long-term surgical outcome and to identify possible prognostic factors in patients with nonlesional neocortical epilepsy.
DESIGN, SETTING, AND PARTICIPANTS: In a surgical cohort from September 1995 to December 2005 at the Seoul National University Hospital, we included 109 consecutive patients without lesions identifiable by magnetic resonance imaging who underwent focal surgical resection for drug-resistant neocortical epilepsy. Follow-up information for at least 10 years was available for all but 1 patient.
Univariate and standard multiple logistic regression analyses were performed to identify the predictors of surgical outcomes, and a generalized estimation equation model was used for the longitudinal multiple logistic regression analysis of up to 21 years of follow-up.
The patients consisted of 64 men and 45 women with ages at surgery ranging from 7 to 56 years (mean [SD], 27.1 [7.8] years). At 1 year after surgery, 59 of 109 patients (54.1%) achieved seizure freedom, and 64 of 108 patients (59.3%) achieved seizure freedom at the last follow-up. Only 11 of 108 patients (10.2%) experienced definite changes in postoperative seizure status. Localizing patterns in functional neuroimaging (strongest odds ratio [OR], 0.30 [95% CI, 0.14-0.66] for fluorodeoxyglucose-positron emission tomography; 0.37 [95% CI, 0.15-0.87] for ictal single-photon emission computed tomography), concordant results in presurgical diagnostic evaluations (OR, 3.15 [95% CI, 1.42-7.02]), the presence of aura (OR, 3.49 [95% CI, 1.54-7.92]), and complete resection of areas of ictal onset with frequent interictal spikes during the intracranial electroencephalographic study (OR, 0.37 [95% CI, 0.16-0.85]) were favorable surgical outcome predictors.
Our study showed that nearly 60% of patients with nonlesional neocortical epilepsy achieved freedom from long-term seizure, and that changes in postoperative seizure status were rarely observed. Several predictors of favorable surgical outcomes were identified, which can help select optimal candidates for surgical treatment among patients with nonlesional neocortical epilepsy.
最近，非病变性新皮质癫痫的手术比例有所增加，而内侧颞叶癫痫的手术比例有所下降。然而，关于非病变性新皮质癫痫患者的长期手术结果和潜在的预后因素的研究仅有少数。
评估非病变性新皮质癫痫患者的长期手术结果并确定可能的预后因素。
设计、地点和参与者：在首尔国立大学医院于 1995 年 9 月至 2005 年 12 月期间的一项外科队列研究中，我们纳入了 109 例连续患者，这些患者无磁共振成像可识别的病变，且接受了药物难治性新皮质癫痫的局灶性手术切除。所有患者均获得了至少 10 年的随访信息，但有 1 例患者除外。
采用单变量和标准多逻辑回归分析来确定手术结果的预测因素，并使用广义估计方程模型对长达 21 年的随访进行纵向多逻辑回归分析。
患者由 64 名男性和 45 名女性组成，手术时年龄为 7 至 56 岁（平均[标准差]，27.1[7.8]岁）。术后 1 年时，109 例患者中有 59 例（54.1%）达到无癫痫发作，108 例患者中有 64 例（59.3%）达到无癫痫发作。在最后一次随访时，仅有 11 例患者（10.2%）的术后癫痫发作状态发生了明确改变。功能神经影像学中的定位模式（氟脱氧葡萄糖正电子发射断层扫描最强优势比[OR]，0.30[95%CI，0.14-0.66]；发作期单光子发射计算机断层扫描 OR，0.37[95%CI，0.15-0.87]），术前诊断评估的一致性结果（OR，3.15[95%CI，1.42-7.02]），先兆（OR，3.49[95%CI，1.54-7.92]）和颅内脑电图研究中发作起始区的完全切除伴有频繁的发作间期棘波（OR，0.37[95%CI，0.16-0.85]）是手术结果的有利预测因素。
我们的研究表明，近 60%的非病变性新皮质癫痫患者达到了长期无癫痫发作的效果，并且很少观察到术后癫痫发作状态的改变。确定了一些有利手术结果的预测因素，这有助于在非病变性新皮质癫痫患者中选择最佳手术治疗的候选者。
