APHM, Timone Hospital, Clinical Ne-urophysiology and Epileptology De-partment, Marseille, France.
Aix-Mar-seille Université, Institut de Neuroscience des Systèmes, INSERM UMR_S 1106, Marseille, France.
Neurosurgery. 2018 Aug 1;83(2):217-225. doi: 10.1093/neuros/nyx342.
Resective surgery established treatment for pharmacoresistant frontal lobe epilepsy (FLE), but seizure outcome and prognostic indicators are poorly characterized and vary between studies.
To study long-term seizure outcome and identify prognostic factors.
We retrospectively analyzed 42 FLE patients having undergone surgical resection, mostly preceded by invasive recordings with stereoelectroencephalography (SEEG). Postsurgical outcome up to 10-yr follow-up and prognostic indicators were analyzed using Kaplan-Meier analysis and multivariate and conditional inference procedures.
At the time of last follow-up, 57.1% of patients were seizure-free. The estimated chance of seizure freedom was 67% (95% confidence interval [CI]: 54-83) at 6 mo, 59% (95% CI: 46-76) at 1 yr, 53% (95% CI: 40-71) at 2 yr, and 46% (95% CI: 32-66) at 5 yr. Most relapses (83%) occurred within the first 12 mo. Multivariate analysis showed that completeness of resection of the epileptogenic zone (EZ) as defined by SEEG was the main predictor of seizure outcome. According to conditional inference trees, in patients with complete resection of the EZ, focal cortical dysplasia as etiology and focal EZ were positive prognostic indicators. No difference in outcome was found in patients with positive vs negative magnetic resonance imaging.
Surgical resection in drug-resistant FLE can be a successful therapeutic approach, even in the absence of neuroradiologically visible lesions. SEEG may be highly useful in both nonlesional and lesional FLE cases, because complete resection of the EZ as defined by SEEG is associated with better prognosis.
对于药物难治性额叶癫痫（FLE），切除术确立了治疗方法，但癫痫发作的结果和预后指标的特征描述较差，且在不同研究中存在差异。
研究长期癫痫发作结果并确定预后因素。
我们回顾性分析了 42 例接受手术切除的 FLE 患者，这些患者大多数在立体脑电图（SEEG）引导下进行了侵入性记录。使用 Kaplan-Meier 分析和多变量及条件推理程序分析术后结果和预后因素。
在最后一次随访时，57.1%的患者无癫痫发作。在 6 个月时，癫痫无发作的估计机会为 67%（95%置信区间：54-83），在 1 年时为 59%（95%置信区间：46-76），在 2 年时为 53%（95%置信区间：40-71），在 5 年时为 46%（95%置信区间：32-66）。大多数复发（83%）发生在最初的 12 个月内。多变量分析表明，SEEG 定义的致痫区（EZ）的完全切除是癫痫发作结果的主要预测因素。根据条件推理树，在 EZ 完全切除的患者中，局灶性皮质发育不良作为病因和局灶性 EZ 是阳性预后指标。在有或无磁共振成像阳性结果的患者中，结果无差异。
对于耐药性 FLE，手术切除可以是一种成功的治疗方法，即使在没有神经影像学可见病变的情况下也是如此。SEEG 在无病变和病变 FLE 病例中可能非常有用，因为 SEEG 定义的 EZ 完全切除与更好的预后相关。
