Morace Roberta, Casciato Sara, Quarato Pier Paolo, Mascia Addolorata, D'Aniello Alfredo, Grammaldo Liliana G, De Risi Marco, Di Gennaro Giancarlo, Esposito Vincenzo
IRCCS "NEUROMED", Pozzilli, IS, Italy.
IRCCS "NEUROMED", Pozzilli, IS, Italy.
Epilepsy Behav. 2019 Jan;90:93-98. doi: 10.1016/j.yebeh.2018.10.033. Epub 2018 Dec 3.
The purpose of this study was to report long-term seizure outcome in patients who underwent frontal lobe epilepsy (FLE) surgery.
This retrospective study included 44 consecutive subjects who underwent resective surgery for intractable FLE at IRCCS NEUROMED (period 2001-2014), followed up for at least 2 years (mean: 8.7 years). All patients underwent noninvasive presurgical evaluation and/or invasive electroencephalography (EEG) monitoring when nonconcordant data were obtained or epileptogenic zone was hypothesized to be close to the eloquent cortex. Electroclinical, neuroimaging, surgical data, and histology were compared to seizure outcome.
Mean epilepsy duration was 19 years; mean age at surgery was 31.6 years. Preoperative magnetic resonance imaging (MRI) showed a frontal lesion in 86.4 % of cases. Scalp video-electroencephalography (VEEG) monitoring detected a focal ictal onset in 90% of cases. Twenty-seven patients (61.4%) underwent invasive recordings. Resections involved dorsolateral (47.7%), medial (9%), orbital (13.6%), and rolandic (13.6%) region. Lobectomy within functional boundaries was performed in the remaining 7 cases (16%). Transient and permanent neurological deficits were observed in 2 and 3 cases, respectively. Histology revealed focal cortical dysplasia (45.5%), World Health Organization (WHO) I-II grade tumors (15.9%), gliosis (22.7%), vascular malformations (4.5%), Rasmussen encephalitis (6.8%), and normal tissue (4.5%). At last observation 68.1% of patients were in Engel's class I, 11.4% in class II, 9% in class III, and 11.4% in class IV. A favorable outcome was associated with focal ictal scalp EEG onset (p = 0.0357).
Surgery is a safe treatment option in drug-resistant FLE with a satisfying long-term outcome. These data highlight the importance of an appropriate selection of potential surgical candidates.
本研究旨在报告接受额叶癫痫（FLE）手术患者的长期癫痫发作结局。
这项回顾性研究纳入了44例在IRCCS神经医学中心（2001 - 2014年期间）接受顽固性FLE切除手术的连续患者，随访至少2年（平均：8.7年）。当获得不一致的数据或癫痫病灶区被推测靠近功能区皮层时，所有患者均接受了非侵入性术前评估和/或侵入性脑电图（EEG）监测。将电临床、神经影像学、手术数据和组织学与癫痫发作结局进行比较。
平均癫痫病程为19年；手术时的平均年龄为31.6岁。术前磁共振成像（MRI）显示86.4%的病例存在额叶病变。头皮视频脑电图（VEEG）监测在90%的病例中检测到局灶性发作起始。27例患者（61.4%）接受了侵入性记录。切除范围涉及背外侧（47.7%）、内侧（9%）、眶部（13.6%）和中央沟周围（13.6%）区域。其余7例（16%）患者在功能边界内进行了叶切除术。分别有2例和3例患者出现了短暂性和永久性神经功能缺损。组织学检查显示局灶性皮质发育异常（45.5%）、世界卫生组织（WHO）I - II级肿瘤（15.9%）、胶质增生（22.7%）、血管畸形（4.5%）、拉斯穆森脑炎（6.8%）和正常组织（4.5%）。在最后一次观察时，68.1%的患者处于恩格尔I级，11.4%处于II级，9%处于III级，11.4%处于IV级。良好的结局与局灶性发作头皮EEG起始相关（p = 0.0357）。
手术是治疗耐药性FLE的一种安全选择，长期结局令人满意。这些数据突出了适当选择潜在手术候选者的重要性。
