Neuroimaging Laboratory, Department of Neurology, State University of Campinas, Campinas,, São Paulo, Brazil.
Epilepsia. 2018 Feb;59(2):410-419. doi: 10.1111/epi.13977. Epub 2017 Dec 13.
To compare surgical outcome in mesial temporal lobe epilepsy (MTLE) patients with unilateral hippocampal sclerosis (MTLE-HS) who had or did not have preoperative video-electroencephalographic monitoring (VEEG).
A prospective study was undertaken with 166 consecutive pharmacoresistant unilateral MTLE-HS patients. All patients were investigated with detailed seizure semiology, serial routine outpatient EEG, magnetic resonance imaging, neuropsychological evaluation, and if necessary, other examinations. Postoperative follow-up ranged between 2 and 16 years. Patients were divided into: (1) patients operated on based on routine outpatient EEG information, with >80% of EEGs with unilateral interictal epileptiform discharges (IEDs) ipsilateral to HS or ictal events (n = 71); and (2) patients submitted to preoperative VEEG (n = 95). To avoid the bias generated by ictal recordings, we performed a subanalysis of: (1) patients without preoperatively ictal recordings (n = 80) and (2) patients with ictal recordings in VEEG or routine outpatient EEG (n = 86).
Groups were similar regarding gender, age at surgery, seizure onset, preoperative seizure frequency, and duration of follow-up. Overall, 136/166 (81.92%) were classified as Engel I seizure outcome, with no difference between groups; 76.84% and 88.73% of patients with and without VEEG, respectively, had Engel I postoperative seizure outcome (P = .77). The time lag until surgery was shorter in the group without VEEG (80 vs 38 months; P = .01). Considering ictal recordings, 76.74% of patients with seizures recorded and 87.50% without ictal recordings had Engel I outcome (P = .11).
We performed the first prospective study in a tertiary epilepsy center comparing surgical outcomes in unilateral MTLE-HS patients investigated preoperatively with and without VEEG. Based on the surgical outcome, VEEG is not imperative in patients with unilateral MTLE-HS who have compatible semiology and clearly ipsilateralized IEDs evaluated by a multidisciplinary and experienced epilepsy group.
比较单侧海马硬化（MTLE-HS）伴或不伴术前视频-脑电图监测（VEEG）的颞叶内侧癫痫（MTLE）患者的手术结果。
对 166 例连续的耐药性单侧 MTLE-HS 患者进行前瞻性研究。所有患者均进行详细的发作半定侧、连续的常规门诊脑电图、磁共振成像、神经心理学评估，如果必要，还进行其他检查。术后随访时间为 2 至 16 年。患者分为：（1）根据常规门诊脑电图信息进行手术的患者，脑电图有 80%以上的局灶性发作间期癫痫样放电（IEDs）或痫性事件同侧于 HS（n=71）；（2）接受术前 VEEG 的患者（n=95）。为了避免痫性发作记录带来的偏差，我们进行了亚分析：（1）无术前痫性发作记录的患者（n=80）；（2）VEEG 或常规门诊脑电图中有痫性发作记录的患者（n=86）。
两组在性别、手术年龄、发作起始年龄、术前发作频率和随访时间方面相似。总的来说，166 例中有 136 例（81.92%）的术后癫痫发作被归类为 Engel I 级，两组之间无差异；未行 VEEG 的患者中有 76.84%和行 VEEG 的患者中有 88.73%（P=0.77）术后癫痫发作达到 Engel I 级。无 VEEG 组的手术时间间隔较短（80 个月 vs 38 个月；P=0.01）。考虑到痫性发作，有痫性发作记录的患者中有 76.74%和无痫性发作记录的患者中有 87.50%的患者术后癫痫发作达到 Engel I 级（P=0.11）。
我们在一家三级癫痫中心进行了首例前瞻性研究，比较了单侧 MTLE-HS 患者术前是否进行 VEEG 检查的手术结果。根据手术结果，对于具有匹配的半定侧特征和经验丰富的癫痫小组评估的明显同侧化 IEDs 的单侧 MTLE-HS 患者，VEEG 并非必须。
