Moon Hye-Jin, Kim Dong Wook, Chung Chun-Kee, Shin Jung-Won, Moon Jangsup, Kang Bong Su, Lee Soon-Tae, Jung Keun-Hwa, Chu Kon, Jung Ki-Young, Cho Yong Won, Lee Sang Kun
Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Korea.
Department of Neurology, Konkuk University School of Medicine, Seoul, Korea.
J Epilepsy Res. 2016 Dec 31;6(2):66-74. doi: 10.14581/jer.16013. eCollection 2016 Dec.
It is crucial to make selection strategy to identify surgical candidates among medically refractory MRI-negative neocortical epilepsy patients. In our previous study, we suggested two or more concordance between noninvasive studies (EEG, ictal scalp EEG, interictal FDG-PET, and SPECT) as a new patient selection strategy for MRI-negative neocortical epilepsy surgery. The objective of this study was to evaluate the surgical outcomes of MRI-negative neocortical epilepsy patients before and after the implementation of a new selection strategy.
From 1995 to 2011, we included 153 consecutive MRI-negative neocortical epilepsy patients who received focal resection and had a follow-up period of at least 2 years. These patients were divided into two groups according to their date of surgery (before and after July 2002). The old group consisted of 89 patients and the new one consisted of 53 patients. Clinical characteristics, presurgical evaluations, and pathology were reviewed.
The new patient selection strategy led to a significant increase in the concordance between two or more modalities. The improvement in surgical outcome after 2002 was significant (seizure-free outcome, 47.2% vs. 75.5%; = 0.001). Concordance between two or more presurgical evaluations and localizing PET were related to a seizure-free outcome in a multivariate analysis.
After a change in surgical strategy to select patients with two or more concordance between noninvasive studies, the seizure-free outcome improved up to 75.5%. MRI-negative neocortical epilepsy patients with two or more concordance between noninvasive studies seem to be good candidates for epilepsy surgery.
制定选择策略以在药物难治性MRI阴性新皮质癫痫患者中识别手术候选者至关重要。在我们之前的研究中，我们提出非侵入性检查（脑电图、发作期头皮脑电图、发作间期氟代脱氧葡萄糖正电子发射断层显像和单光子发射计算机断层扫描）之间的两种或更多种一致性作为MRI阴性新皮质癫痫手术的一种新的患者选择策略。本研究的目的是评估新选择策略实施前后MRI阴性新皮质癫痫患者的手术结果。
1995年至2011年，我们纳入了153例连续的接受局灶性切除且随访期至少2年的MRI阴性新皮质癫痫患者。这些患者根据手术日期（2002年7月前后）分为两组。旧组由89例患者组成，新组由53例患者组成。回顾了临床特征、术前评估和病理情况。
新的患者选择策略导致两种或更多种检查方式之间的一致性显著增加。2002年后手术结果的改善显著（无癫痫发作结果，47.2%对75.5%；P = 0.001）。在多变量分析中，两种或更多种术前评估与定位正电子发射断层显像之间的一致性与无癫痫发作结果相关。
在改变手术策略以选择非侵入性检查之间有两种或更多种一致性的患者后，无癫痫发作结果提高到了75.5%。非侵入性检查之间有两种或更多种一致性的MRI阴性新皮质癫痫患者似乎是癫痫手术的良好候选者。
