Ochoa Juan G, Hentgarden Diana, Paulzak Audrey, Ogden Melissa, Pryson Richard, Lammle Markus, Rusyniak Walter G
Department of Neurology, University of South Alabama, United States.
Department of Neurology, University of South Alabama, United States.
Epilepsy Behav. 2017 Jun;71(Pt A):17-22. doi: 10.1016/j.yebeh.2017.01.001. Epub 2017 Apr 22.
This was a prospective observational study to correlate the clinical symptoms, electrophysiology, imaging, and surgical pathology of patients with temporal lobe epilepsy (TLE) without hippocampal sclerosis. We selected consecutive patients with TLE and normal MRI undergoing temporal lobe resection between April and September 2015. Clinical features, imaging, and functional data were reviewed. Intracranial monitoring and language mapping were performed when it was required according to our team recommendation. Prior to hippocampal resection, intraoperative electrocorticography was performed using depth electrodes in the amygdala and the hippocampus. The resected hippocampus was sent for pathological analysis.
Five patients with diagnosis with non-lesional TLE were included. We did not find distinctive clinical features that could be a characteristic of non-lesional TLE. The mean follow-up was 13.2months (11-15months); 80% of patients achieved Engel Class I outcome. There was no distinctive electrographic findings in these patients. Histopathologic analysis was negative for mesial temporal sclerosis. A second blinded independent neuropathologist with expertise in epilepsy found ILAE type I focal cortical dysplasia in the parahippocampal gyrus in all patients. A third independent neuropathologist reported changes in layer 2 with larger pyramidal neurons in 4 cases but concluded that none of these cases met the diagnostic criteria of FCD. Subtle pathological changes could be associated with a parahippocampal epileptic zone and should be investigated in patients with MRI-negative TLE. This study also highlights the lack of interobserver reliability for the diagnosis of mild cortical dysplasia. Finally, selective amygdalo-hippocampectomy or laser ablation of the hippocampus may not control intractable epilepsy in this specific population.
这是一项前瞻性观察性研究，旨在关联无海马硬化的颞叶癫痫（TLE）患者的临床症状、电生理学、影像学和手术病理学。我们选取了2015年4月至9月间连续接受颞叶切除术且MRI正常的TLE患者。回顾了临床特征、影像学和功能数据。根据我们团队的建议，在需要时进行颅内监测和语言定位。在海马切除术前，使用深度电极在杏仁核和海马体进行术中皮质脑电图检查。将切除的海马体送去做病理分析。
纳入了5例诊断为非病变性TLE的患者。我们未发现可作为非病变性TLE特征的独特临床特征。平均随访时间为13.2个月（11 - 15个月）；80%的患者达到恩格尔I级预后。这些患者没有独特的脑电图表现。组织病理学分析显示内侧颞叶硬化为阴性。另一位在癫痫方面有专长的独立盲法神经病理学家在所有患者的海马旁回中发现了国际抗癫痫联盟（ILAE）I型局灶性皮质发育异常。第三位独立神经病理学家报告4例患者第2层有较大锥体细胞的改变，但得出结论认为这些病例均不符合FCD的诊断标准。细微的病理改变可能与海马旁癫痫区有关，MRI阴性的TLE患者应进行调查。本研究还强调了在轻度皮质发育异常诊断中观察者间可靠性的缺乏。最后，选择性杏仁核 - 海马切除术或海马体激光消融术可能无法控制这一特定人群的难治性癫痫。
