From the Department of Neurology (E.G., L.B.) and Center for Biomedical Imaging (J.J.), Medical University of South Carolina, Charleston; Department of Neurology (D.L.D., N.P.), Emory University, Atlanta, GA; Institute of Systems, Molecular and Integrative Biology (S.S.K., C.d.B.), University of Liverpool; The Walton Centre NHS Foundation Trust (S.S.K.), Liverpool, UK; Department of Neurology (K.A.D.), University of Pennsylvania, Philadelphia; Department of Neurosurgery (R.G., J.T.W.), Emory University, Atlanta, GA; Department of Neurological Surgery (J.T.W.), Washington University in St. Louis, MO; and Department of Neurology (R.K.), Hofstra University/Northwell, NY.
Neurology. 2022 Jan 11;98(2):e141-e151. doi: 10.1212/WNL.0000000000013033. Epub 2021 Oct 29.
To determine the association between surgical lesions of distinct gray and white structures and connections with favorable postoperative seizure outcomes.
Patients with drug-resistant temporal lobe epilepsy (TLE) from 3 epilepsy centers were included. We employed a voxel-based and connectome-based mapping approach to determine the association between favorable outcomes and surgery-induced temporal lesions. Analyses were conducted controlling for multiple confounders, including total surgical resection/ablation volume, hippocampal volumes, side of surgery, and site where the patient was treated.
The cohort included 113 patients with TLE (54 women; 86 right-handed; mean age at seizure onset 16.5 years [SD 11.9]; 54.9% left) who were 61.1% free of disabling seizures (Engel Class 1) at follow-up. Postoperative seizure freedom in TLE was associated with (1) surgical lesions that targeted the hippocampus as well as the amygdala-piriform cortex complex and entorhinal cortices; (2) disconnection of temporal, frontal, and limbic regions through loss of white matter tracts within the uncinate fasciculus, anterior commissure, and fornix; and (3) functional disconnection of the frontal (superior and middle frontal gyri, orbitofrontal region) and temporal (superior and middle pole) lobes.
Better postoperative seizure freedom is associated with surgical lesions of specific structures and connections throughout the temporal lobes. These findings shed light on the key components of epileptogenic networks in TLE and constitute a promising source of new evidence for future improvements in surgical interventions.
This study provides Class II evidence that for patients with TLE, postoperative seizure freedom is associated with surgical lesions of specific temporal lobe structures and connections.
确定不同灰质和白质结构的手术损伤与术后良好癫痫发作结局之间的关联。
纳入来自 3 个癫痫中心的耐药性颞叶癫痫（TLE）患者。我们采用基于体素和连接组映射的方法来确定与良好结果相关的手术引起的颞叶损伤。分析控制了多种混杂因素，包括总手术切除/消融体积、海马体积、手术侧和患者治疗地点。
该队列包括 113 名 TLE 患者（54 名女性；86 名右利手；发病年龄 16.5 岁[SD 11.9]；54.9%为左侧），随访时 61.1%的患者无残疾性癫痫发作（Engel 分级 1）。TLE 术后无癫痫发作与以下因素相关：（1）针对海马体以及杏仁核-梨状皮质复合体和内嗅皮质的手术损伤；（2）通过钩束、前连合和穹窿内的白质束丢失，导致颞叶、额叶和边缘区域的连接中断；（3）额（额上和额中回、眶额区域）和颞（上和中极）叶的功能连接中断。
更好的术后无癫痫发作与特定结构和连接的手术损伤有关。这些发现揭示了 TLE 中致痫网络的关键组成部分，并为未来手术干预的改进提供了新的有希望的证据来源。
这项研究提供了 II 级证据，表明对于 TLE 患者，术后无癫痫发作与特定的颞叶结构和连接的手术损伤有关。
