Epileptology Unit, AP-HP Pitié-Salpêtrière Hospital, Paris, France.
Rehabilitation Unit, AP-HP Pitié-Salpêtrière Hospital, Paris, France.
Epilepsia. 2020 Oct;61(10):e146-e152. doi: 10.1111/epi.16693. Epub 2020 Oct 14.
Temporal pole epilepsy (TPE) is a poorly known and difficult to individualize subtype of temporal lobe epilepsy. Consequently, in drug-resistant TPE, there is still a debate on the need for a large surgical removal of the temporal pole and mesial temporal structures or a limited resection of the temporal pole. We reviewed all patients who underwent presurgical evaluation for drug-resistant epilepsy over a 17-year period, and report here 19 patients with proven drug-resistant temporal pole epilepsy who underwent a selective temporal pole resection with respect to mesial structures. Most (15) TPE patients exhibited seizures resembling mesiotemporal seizures, whereas the others exhibited nocturnal hyperkinetic seizures or an association of both seizure types. MRI revealed a temporal pole lesion in 58% of patients. Long-term postoperative outcome after a conservative surgery was excellent: 63% of patients were seizure-free (International League Against Epilepsy [ILAE] 1) at 1-year postsurgery and 78% at 5 years. These results show that TPE has no specific electroclinical features but is a distinct type of temporal lobe epilepsy allowing a conservative surgery. Respecting the mesiotemporal structures is a valid surgical approach for drug-resistant temporal pole epilepsy.
颞极癫痫（TPE）是一种不太为人所知且难以个体化的颞叶癫痫亚型。因此，对于耐药性 TPE，关于是否需要对颞极和内侧颞叶结构进行大范围切除或颞极有限切除，仍存在争议。我们回顾了过去 17 年间接受耐药性癫痫术前评估的所有患者，并在此报告 19 例经证实的耐药性颞极癫痫患者，这些患者在进行内侧结构选择性颞极切除时考虑了颞极。大多数（15 例）TPE 患者表现出类似于内侧颞叶发作的发作，而其他患者表现出夜间多动性发作或两种发作类型的结合。MRI 在 58%的患者中显示颞极病变。保守手术后的长期术后结果非常出色：1 年后 63%的患者无癫痫发作（国际抗癫痫联盟 [ILAE] 1 级），5 年后 78%的患者无癫痫发作。这些结果表明，TPE 没有特定的电临床特征，但它是一种独特的颞叶癫痫类型，可以进行保守手术。保留内侧颞叶结构是耐药性颞极癫痫的有效手术方法。
