局灶性皮质发育不良及其亚型的手术结局预测因素。
Predictors of surgical outcome in focal cortical dysplasia and its subtypes.
机构信息
Departments of1Neurology.
2Radiology.
出版信息
J Neurosurg. 2021 Jul 30;136(2):512-522. doi: 10.3171/2020.12.JNS203385. Print 2022 Feb 1.
OBJECTIVE
The authors analyzed predictors of surgical outcome in patients with focal cortical dysplasia (FCD) and its ILAE (International League Against Epilepsy) subtypes after noninvasive multimodal evaluation and calculated time to first seizure.
METHODS
Data of 355 patients with refractory epilepsy, confirmed FCD pathology, and 2-13 years of postsurgical follow-up were analyzed to determine the predictive roles of clinical, EEG, imaging, and surgical factors that influence seizure freedom.
RESULTS
The mean ± SD age at surgery was 20.26 ± 12.18 years. In total, 142 (40.0%) patients had daily seizures and 90 (25.3%) had multiple seizure types. MRI showed clear-cut FCD in 289 (81.4%) patients. Pathology suggested type I FCD in 27.3% of patients, type II in 28.4%, and type III in 42.8% of patients. At latest follow-up, 72.1% of patients were seizure free and 11.8% were seizure free and not receiving antiepileptic drugs. Among the subtypes, 88.8% of patients with type III, 69.3% with type II, and 50.5% with type I FCD were seizure free. Multiple seizure types, acute postoperative seizures (APOS), and type I FCD were predictors of persistent seizures, whereas type III FCD was the strongest predictor of seizure freedom. Type I FCD was associated with daily seizures, frontal and multilobar distribution, subtle findings on MRI, incomplete resection, and persistent seizures. Type II and III FCD were associated with clear-cut lesion on MRI, regional interictal and ictal EEG onset pattern, focal pattern on ictal SPECT, complete resection, and seizure freedom. Type III FCD was associated with temporal location, whereas type I and II FCD were associated with extratemporal location. Nearly 80% of patients with persistent seizures, mostly those with type I FCD, had their first seizure within 6 months postsurgery.
CONCLUSIONS
Long-term seizure freedom after surgery can be achieved in more than two-thirds of patients with FCD after noninvasive multimodal evaluation. Multiple seizure types, type I FCD, and APOS were predictors of persistent seizures. Seizures recurred in about 80% of patients within 6 months postsurgery.
目的
作者分析了经非侵入性多模态评估后，局灶性皮质发育不良（FCD）及其国际抗癫痫联盟（ILAE）亚型患者的手术结果预测因素，并计算了首次发作的时间。
方法
分析了 355 例难治性癫痫、证实为 FCD 病理学、术后 2-13 年随访的患者数据，以确定影响无癫痫发作的临床、脑电图、影像学和手术因素的预测作用。
结果
手术时的平均年龄为 20.26±12.18 岁。共有 142 例（40.0%）患者有每日发作，90 例（25.3%）有多种发作类型。289 例（81.4%）患者的 MRI 显示明确的 FCD。病理学提示 27.3%的患者为 I 型 FCD，28.4%为 II 型，42.8%为 III 型。在最近的随访中，72.1%的患者无癫痫发作，11.8%的患者无癫痫发作且未服用抗癫痫药物。在各亚型中，III 型患者中 88.8%、II 型患者中 69.3%、I 型患者中 50.5%无癫痫发作。多灶性发作类型、急性术后发作（APOS）和 I 型 FCD 是持续性癫痫发作的预测因素，而 III 型 FCD 是最强的无癫痫发作预测因素。I 型 FCD 与每日发作、额区和多脑区分布、MRI 上细微表现、不完全切除和持续性癫痫发作有关。II 型和 III 型 FCD 与 MRI 上明确的病变、区域性发作间期和发作期脑电图起始模式、发作期 SPECT 上局灶性模式、完全切除和无癫痫发作有关。III 型 FCD 与颞叶位置有关，而 I 型和 II 型 FCD 与颞外位置有关。近 80%的持续性癫痫发作患者，主要是 I 型 FCD 患者，在术后 6 个月内首次发作。
结论
经过非侵入性多模态评估后，超过三分之二的 FCD 患者手术后可实现长期无癫痫发作。多灶性发作类型、I 型 FCD 和 APOS 是持续性癫痫发作的预测因素。约 80%的患者在术后 6 个月内再次出现癫痫发作。
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