Serviço de Neurocirurgia, Departamento de Ciências Neurológicas, Hospital de Base de São José do Rio Preto - Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto.
Universidade Federal de Sergipe, Aracaju.
Eur J Neurol. 2018 Nov;25(11):1372-1377. doi: 10.1111/ene.13740. Epub 2018 Aug 3.
Anterior temporal lobectomy for mesial temporal sclerosis (MTS) is a very effective measure for the control of seizures, and the probability of becoming seizure-free is approximately 70-90%. However, 30% of patients still experience seizures after surgery. An aura is a subjective ictal phenomenon that may precede an observable seizure. However, there are few studies on the prognostic factor aura although, being the initial symptoms of epileptic seizures, many types of auras have significant localizing or lateralizing value. This study hypothesized that the type of pre-operative aura may predict the post-surgical outcome in patients with medically refractory temporal lobe epilepsy due to MTS.
Of 1214 patients evaluated for surgery in the Epilepsy Center of Faculdade de Medicina de São Jose do Rio Preto (FAMERP), a tertiary Brazilian epilepsy center, 400 underwent anterior temporal lobectomy (ATL) for MTS. The number and type of auras were analyzed and compared with the Engel classification for outcome.
Analyzing the patients by the type of aura, those who had extratemporal auras had the worst post-surgical result according to the Engel classification. Although mesial auras are apparently a good prognostic factor, patients without aura also had a worse prognosis. There were no differences between simple and multiple auras. To identify the most appropriate candidates for ATL, it is very important to consider the favorable prognostic factors for counseling patients in daily practice.
Patients with symptoms and clinical signs that suggest extratemporal involvement may have unfavorable outcomes.
对于内侧颞叶硬化症（MTS）患者，行前颞叶切除术是一种非常有效的控制癫痫发作的手段，其无癫痫发作的概率约为 70-90%。然而，术后仍有 30%的患者出现癫痫发作。先兆是一种可能先于可观察到的癫痫发作的主观癫痫发作现象。然而，尽管先兆是癫痫发作的初始症状，但由于存在多种类型的先兆，它们具有重要的定位或侧化价值，因此针对其预后因素的研究却很少。本研究假设术前先兆的类型可能预测因 MTS 而导致药物难治性颞叶癫痫患者的术后结果。
在巴西三级癫痫中心圣若泽-杜里奥普雷图医学院癫痫中心（FAMERP）接受手术评估的 1214 名患者中，有 400 名患者接受了前颞叶切除术（ATL）治疗 MTS。分析了先兆的数量和类型，并与手术结果的 Engel 分级进行了比较。
根据先兆类型对患者进行分析，那些出现皮质外先兆的患者根据 Engel 分级术后结果最差。尽管内侧先兆显然是一个良好的预后因素，但无先兆的患者预后也较差。单纯先兆和多种先兆之间无差异。在日常实践中为患者提供咨询时，考虑到有利的预后因素，对于确定最适合行 ATL 的患者非常重要。
出现提示皮质外受累的症状和临床体征的患者可能预后不佳。
