Epilepsy Research Centre, Department of Medicine (Austin Health), University of Melbourne, Melbourne, Victoria, Australia.
Bladin-Berkovic Comprehensive Epilepsy Program, Department of Neurology, Austin Health, Melbourne, Victoria, Australia.
Epilepsia. 2023 Jan;64(1):92-102. doi: 10.1111/epi.17440. Epub 2022 Nov 14.
Anterior temporal lobectomy (ATL) for medication-resistant localized epilepsy results in ablation or reduction of seizures for most patients. However, some individuals who attain an initial extended period of postsurgical seizure freedom will experience a later seizure recurrence. In this study, we examined the prevalence and some risk factors for late recurrence in an ATL cohort with extensive regular follow-up.
Included were 449 patients who underwent ATL at Austin Health, Australia, from 1978 to 2008. Postsurgical follow-up was undertaken 2-3 yearly. Seizure recurrence was tested using Kaplan-Meier analysis, log-rank test, and Cox regression. Late recurrence was qualified as a first disabling seizure >2 years postsurgery. We examined risks within the ATL cohort according to broad pathology groups and tested whether late recurrence differed for the ATL cohort compared to patients who had resections outside the temporal lobe (n = 98).
Median post-ATL follow-up was 22 years (range = .1-38.6), 6% were lost to follow-up, and 12% had died. Probabilities for remaining completely seizure-free after surgery were 51% (95% confidence interval [CI] = 53-63) at 2 postoperative years, 36% (95% CI = 32-41) at 10 years, 32% (95% CI = 27-36) at 20 years, and 30% (95% CI = 25-34) at 25 years. Recurrences were reported up to 23 years postoperatively. Late seizures occurred in all major ATL pathology groups, with increased risk in the "normal" and "distant lesion" groups (p ≤ .03). Comparison between the ATL cohort and patients who underwent extratemporal resection demonstrated similar patterns of late recurrence (p = .74).
Some first recurrences were very late, reported decades after ATL. Late recurrences were not unique to any broad ATL pathology group and did not differ according to whether resections were ATL or extratemporal. Reports of these events by patients with residual pathology suggest that potentially epileptogenic abnormalities outside the area of resection may be implicated as one of several possible underlying mechanisms.
对于药物难治性局灶性癫痫患者，行颞叶前切除术（ATL）后大多数患者的癫痫发作会得到消融或减少。然而，一些患者在术后初始延长的无癫痫发作期后会出现晚期癫痫复发。在这项研究中，我们通过广泛的定期随访，检查了 ATL 队列中晚期复发的发生率和一些危险因素。
纳入了 1978 年至 2008 年期间在澳大利亚奥斯汀健康中心行 ATL 的 449 例患者。术后每 2-3 年进行一次随访。使用 Kaplan-Meier 分析、对数秩检验和 Cox 回归来检验癫痫复发情况。晚期复发定义为手术后 2 年以上首次致残性癫痫发作。我们根据广泛的病理学分组检查了 ATL 队列中的风险，并检验了 ATL 队列与颞叶外切除患者（n=98）的晚期复发是否存在差异。
中位 ATL 术后随访时间为 22 年（范围为.1-38.6），6%的患者失访，12%的患者死亡。术后完全无癫痫发作的概率分别为术后 2 年时 51%（95%置信区间 [CI]为 53-63）、10 年时 36%（95% CI 为 32-41）、20 年时 32%（95% CI 为 27-36）和 25 年时 30%（95% CI 为 25-34）。术后至 23 年内有复发报告。晚期癫痫发作发生在所有主要的 ATL 病理学分组中，在“正常”和“远隔病变”组中的风险增加（p≤.03）。ATL 队列与行颞外切除术患者的比较显示，晚期复发的模式相似（p=0.74）。
有些首次复发非常晚，在 ATL 后几十年才报告。晚期复发并非特定于任何广泛的 ATL 病理学分组，并且与切除部位是否为 ATL 或颞外无关。残留病变患者报告这些事件表明，切除区域以外的潜在致痫性异常可能是多种潜在机制之一。
