Lingyue Huang, Hao D U, Lu Xiang, Qin Liu, Lihui L V, Lulu Chen, Guozheng X U
Department of Neurosurgery, Wuhan General Hospital of PLA, Wuhan 430070, China.
Nan Fang Yi Ke Da Xue Xue Bao. 2018 Jul 30;38(7):773-779. doi: 10.3969/j.issn.1673-4254.2018.07.01.
To evaluate seizure outcome in patients receiving surgery for chronic medically intractable mesial temporal lobe epilepsy (MTLE) and analyze its possible predictors.
This retrospective study was conducted in patients with chronic medically intractable MTLE undergoing anterior temporal lobectomy (ATL) or selective amygdalohippocampectomy (SAH) in our department between September, 2011 and October, 2013. The patients were followed up for 3.5 to 5.5 years, during which the seizure outcome was evaluated according to Engel's classification. The clinical data were collected from the patients to identify the possible predictors that affected the outcome of the patients using Mann-Whitney U test or Kruskal-Wallis test.
Atotal of 34 patients were included in this study with a definite diagnosis of chronic medically intractable MTLE after preoperative noninvasive and invasive evaluation. In 4 of these patients, invasive EEG monitoring confirmed that epileptic discharges originated from the bilateral mesial temporal lobe, and hence surgical resection of the epileptogenic zone was not performed. The other 30 patients underwent surgical resection of the epileptogenic zone with ALT or SAH, and favorable outcomes were achieved in 23 (76.7%) of the patients. Of the 7 (23.3%) patients with poor outcomes, 6 patients presented with typical automatism and aura with frequent secondary generalized tonic-clonic seizure, and the other one patient exhibited impaired intelligence. Statistical analysis suggested that the patients without a special disease history (trauma, febrile seizure, or encephalitis) tended to have a more favorable seizure outcome.
Surgical interventions can achieve good therapeutic effect on chronic medically intractable MTLE, and patients without a special disease history may have more favorable outcomes after the surgery. SAH via the superior temporal sulcus approach can be a better surgical option for intractable MTLE.
评估接受手术治疗的慢性药物难治性内侧颞叶癫痫（MTLE）患者的癫痫发作结果，并分析其可能的预测因素。
本回顾性研究纳入了2011年9月至2013年10月期间在我科接受前颞叶切除术（ATL）或选择性杏仁核海马切除术（SAH）的慢性药物难治性MTLE患者。对患者进行了3.5至5.5年的随访，在此期间根据恩格尔分类法评估癫痫发作结果。收集患者的临床数据，使用曼-惠特尼U检验或克鲁斯卡尔-沃利斯检验来确定影响患者预后的可能预测因素。
本研究共纳入34例患者，经术前无创和有创评估后确诊为慢性药物难治性MTLE。其中4例患者经有创脑电图监测证实癫痫放电起源于双侧内侧颞叶，因此未进行癫痫源区的手术切除。其余30例患者接受了ALT或SAH手术切除癫痫源区，23例（76.7%）患者取得了良好的治疗效果。在7例（23.3%）预后不良的患者中，6例表现为典型的自动症和先兆，并频繁继发全面强直-阵挛发作，另1例患者智力受损。统计分析表明，无特殊病史（外伤、热性惊厥或脑炎）的患者癫痫发作预后往往更好。
手术干预对慢性药物难治性MTLE可取得良好的治疗效果，无特殊病史的患者术后可能有更好的预后。经颞上沟入路的SAH可能是难治性MTLE更好的手术选择。
