Department of Neurology, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey.
Department of Neurosurgery, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey.
World Neurosurg. 2023 Apr;172:e483-e489. doi: 10.1016/j.wneu.2023.01.055. Epub 2023 Jan 20.
Lesional posterior cortex epilepsy (PCE) is often drug resistant and may benefit from surgical intervention. In this study, we aimed to identify potential predictive factors associated with seizure recurrence after epilepsy surgery in lesional PCE.
We retrospectively reviewed patients with PCE who underwent surgery between 1998 and 2021. They were divided into 2 groups according to seizure outcome; the seizure-free group (group 1) and the non-seizure-free group (group 2). The relationship among clinical factors, electroencephalography (EEG) or cranial magnetic resonance imaging findings, disease, and seizure outcome was investigated.
A total of 60 patients, with a mean age of 27.26 ± 12.35 years (range, 9-61 years), were included in the study. There were 31 patients (51.66%) in group 1 (Engel class I) and 29 patients (48.33%) in group 2 (13 [21.66%], 10 [16.66%], and 6 [10%] patients in Engel class II, III, and IV, respectively), with a mean follow-up of 8.95 ± 6.96 years (range, 1-24 years). No difference was observed regarding age, gender, age at seizure onset, operation type, treatment gap, and presence of bilateral lesions between the groups (P > 0.05). However, bilateral findings on interictal EEG and gliosis as the underlying disease were predictors of seizure recurrence (P < 0.05).
More than half of the patients (including 2 with bilateral magnetic resonance imaging lesions) were seizure free at long-term follow-up. However, patients with bilateral findings on interictal EEG and gliosis were more likely to have recurrent seizures after surgery. Because lesional PCE is almost always drug resistant and has a potential for favorable outcomes, epilepsy surgery should be considered early.
病灶性后部皮层癫痫（PCE）通常对药物治疗抵抗，可能受益于手术干预。本研究旨在确定病灶性 PCE 患者手术后癫痫发作复发的潜在预测因素。
我们回顾性分析了 1998 年至 2021 年间接受手术的 PCE 患者。根据手术结果将患者分为两组：无癫痫发作组（组 1）和癫痫发作未控制组（组 2）。分析了临床因素、脑电图（EEG）或头颅磁共振成像（MRI）结果、疾病与手术结果之间的关系。
共纳入 60 例患者，平均年龄 27.26±12.35 岁（范围：9-61 岁）。组 1（Engel Ⅰ级）有 31 例（51.66%），组 2（Engel Ⅱ级、Ⅲ级和Ⅳ级分别为 13 例、10 例和 6 例）有 29 例（48.33%），平均随访 8.95±6.96 年（范围：1-24 年）。两组间年龄、性别、发病年龄、手术类型、治疗间隙时间和双侧病灶比例差异均无统计学意义（P＞0.05）。然而，发作间期 EEG 双侧表现和神经胶质增生作为潜在疾病是癫痫发作复发的预测因素（P＜0.05）。
在长期随访中，超过一半的患者（包括 2 例双侧 MRI 病变）无癫痫发作。然而，发作间期 EEG 双侧表现和神经胶质增生的患者术后更有可能出现癫痫发作复发。由于病灶性 PCE 几乎总是对药物治疗抵抗且具有良好的预后潜力，因此应早期考虑手术治疗。
