Oliver B, Russi A
Neurosurgery and Clinical Neurophysiology, Instituto de Neurología y Neurocirugía, Barcelona, Spain.
Acta Neurol Scand Suppl. 1994;152:187-9. doi: 10.1111/j.1600-0404.1994.tb05219.x.
Invasive versus non-invasive epileptogenic zone definition was analyzed in a series of 89 patients operated on for drug-resistant epilepsy. In the group of 69 cortical resections, 26% needed invasive recordings, 13.5% when foreign-tissue lesions had been detected by MRI and 32% when were absent. In this last group temporal resections had invasive EEG recordings in 23.5% versus 54.5% when the epileptogenic zone was extratemporal. In a group of 43 temporal resections with more than one year follow-up MRI has detected some abnormality in 84%. Excluding focal lesions, MRI detected hippocampal/temporal lobe atrophy in 66% of the cases in agreement with other noninvasive tests and in 4% contralateral to the epileptogenic zone located by subdural strips. The outcome analysis showed that 85% of the patients with MRI-EEG agreement were seizure free in contrast to only 43% when MRI was non-lateralizing. Future studies has to be oriented to better understand the epileptic process of patients without MRI abnormalities.
在一组89例因耐药性癫痫接受手术的患者中，分析了侵袭性与非侵袭性致痫区定义。在69例皮质切除术组中，26%需要侵袭性记录，当MRI检测到异物组织病变时为13.5%，无病变时为32%。在最后一组中，颞叶切除术的侵袭性脑电图记录在致痫区位于颞叶外时为23.5%，而在致痫区位于颞叶外时为54.5%。在一组43例随访超过一年的颞叶切除术中，MRI在84%的病例中检测到一些异常。排除局灶性病变后，MRI在66%的病例中检测到海马/颞叶萎缩，这与其他非侵入性检查一致，在4%的病例中与硬膜下条带定位的致痫区对侧。结果分析表明，MRI-EEG一致的患者中有85%无癫痫发作，而MRI无定位作用时只有43%。未来的研究必须致力于更好地理解无MRI异常患者的癫痫过程。
