发作间期癫痫样放电在癫痫手术疗效中的作用

The Role of Interictal Epileptiform Discharges in Epilepsy Surgery Outcome.

作者信息

Mehvari Habibabadi Jafar, Zare Mohamad, Tabrizi Nasim

机构信息

Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

Department of Neurology, Medical School, Mazandaran University of Medical Sciences, Sari, Iran.

出版信息

Int J Prev Med. 2019 Jun 7;10:101. doi: 10.4103/ijpvm.IJPVM_237_18. eCollection 2019.

DOI:10.4103/ijpvm.IJPVM_237_18

PMID:31360348

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6592222/

Abstract

BACKGROUND

Epilepsy surgery is a fundamental treatment in refractory epilepsy. Video electroencephalographic (v-EEG) monitoring plays an essential role in presurgical evaluation of patients. However there are reports of favorable outcome based on interictal and magnetic resonance imaging (MRI) findings without any need for v-EEG monitoring in patients with temporal lobe epilepsy (TLE). This study aimed to investigate the prognostic effect of concordance between interictal findings and ictal and MRI data on postsurgical outcome of TLE and extratemporal lobe epilepsy (ETLE).

METHODS

A retrospective study was conducted on 199 patients with refractory focal epilepsy who were admitted for presurgical evaluation. The concordance between irritative zone (IZ) and seizure onset zone (SOZ) and also IZ and MRI lesion was registered, and subsequently the prognostic effect of relevancy on 1-year follow-up result based on Engel criteria was investigated.

RESULTS

In TLE and ETLE regarding relevancy between IZ and SOZ, 77.8% and 73.2% were concordant, 2.5% and 0% were discordant, and 19.6% and 26.8% had overlap, respectively. Concordance between IZ and MRI lesion was found in 76.6% and 51.2% of patients with TLE and ETLE while discordance was recorded in 2.5% and 12.2% and overlap registered in 20.9% and 36.6%, respectively. The concordance of interictal findings had no effect on postsurgical outcome of patients with TLE and ETLE.

CONCLUSIONS

Our study showed that concordance of IZ with SOZ and MRI has no independent effect on postsurgical outcome of patients with TLE and ETLE. We suggest that excluding exceptional cases, v-EEG monitoring should be considered as the mainstay of presurgical evaluation.

摘要

背景

癫痫手术是治疗难治性癫痫的重要方法。视频脑电图（v-EEG）监测在患者术前评估中起着至关重要的作用。然而，有报道称，基于发作间期和磁共振成像（MRI）结果，颞叶癫痫（TLE）患者无需进行v-EEG监测也能取得良好疗效。本研究旨在探讨发作间期结果与发作期及MRI数据的一致性对TLE和颞叶外癫痫（ETLE）术后结局的预后影响。

方法

对199例因术前评估入院的难治性局灶性癫痫患者进行回顾性研究。记录刺激区（IZ）与癫痫发作起始区（SOZ）以及IZ与MRI病变之间的一致性，随后根据Engel标准研究相关性对1年随访结果的预后影响。

结果

在TLE和ETLE中，关于IZ与SOZ的相关性，一致性分别为77.8%和73.2%，不一致性分别为2.5%和0%，重叠率分别为19.6%和26.8%。TLE和ETLE患者中IZ与MRI病变的一致性分别为76.6%和51.2%，不一致性分别为2.5%和12.2%，重叠率分别为20.9%和36.6%。发作间期结果的一致性对TLE和ETLE患者的术后结局没有影响。