Department of Neurology, Neuroscience Center, Samsung Biomedical Research Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
PLoS One. 2018 Oct 19;13(10):e0206095. doi: 10.1371/journal.pone.0206095. eCollection 2018.
To investigate the long-term postoperative outcomes and predictive factors associated with poor surgical outcomes in mesial temporal lobe epilepsy (MTLE).
We enrolled patients with MTLE who underwent resective surgery at single university-affiliated hospital. Surgical outcomes were determined using a modified Engel classification at the 2nd and 5th years after surgery and the last time of follow-up.
The mean duration of follow-up after surgery was 7.6 ± 3.7 years (range, 5.0-21.0 years). 334 of 400 patients (83.5%) were seizure-free at the 5th postoperative year. Significant predictive factors of a poor outcome at the 5th year were a history of generalized tonic clonic (GTC) seizures (odds ratio, OR; 2.318), bi-temporal interictal epileptiform discharge (IED) (OR; 3.107), bilateral hippocampal sclerosis (HS) (OR; 5.471), unilateral HS and combined extra-hippocampal lesion (OR; 5.029), and bi-temporal hypometabolism (BTH) (OR; 4.438). Bi-temporal IED (hazard ratio, HR; 2.186), BTH (HR; 2.043), bilateral HS (HR; 2.541) and unilateral HS and combined extra-hippocampal lesion (HR; 2.75) were independently associated with seizure recurrence. We performed a subgroup analysis of 208 patients with unilateral HS, and their independent predictors of a poor outcome at the 5th year were BTH (OR; 5.838) and tailored hippocampal resection (OR; 11.053).
This study demonstrates that 16.5% of MTLE patients had poor long-term outcomes after surgery. Bilateral involvement in electrophysiological and imaging studies predicts poor surgical outcomes in MTLE patients.
探讨内侧颞叶癫痫（MTLE）患者术后长期结局和与手术效果不良相关的预测因素。
我们纳入了在单所大学附属医院接受切除术的 MTLE 患者。使用改良的 Engel 分级在术后第 2 年和第 5 年以及最后一次随访时来确定手术结果。
术后随访的平均时间为 7.6±3.7 年（范围，5.0-21.0 年）。334 例患者（83.5%）在术后第 5 年时无癫痫发作。第 5 年预后不良的显著预测因素为全身性强直阵挛发作（GTCS）病史（比值比[OR]，2.318）、双侧间棘波放电（IED）（OR，3.107）、双侧海马硬化（HS）（OR，5.471）、单侧 HS 合并海马外病变（OR，5.029）和双侧颞叶代谢低下（BTH）（OR，4.438）。双侧 IED（HR，2.186）、BTH（HR，2.043）、双侧 HS（HR，2.541）和单侧 HS 合并海马外病变（HR，2.75）与癫痫复发独立相关。我们对 208 例单侧 HS 患者进行了亚组分析，他们第 5 年预后不良的独立预测因素为 BTH（OR，5.838）和定制海马切除术（OR，11.053）。
本研究表明，16.5%的 MTLE 患者手术后长期结局较差。电生理和影像学研究的双侧受累预测 MTLE 患者手术效果不良。
