Adam C, Clemenceau S, Semah F, Hasboun D, Samson S, Aboujaoude N, Samson Y, Baulac M
Service de Neurophysiologie, Hôpital de la Pitié-Salpêtrière, Paris, France.
Acta Neurol Scand. 1996 Jul;94(1):1-11. doi: 10.1111/j.1600-0404.1996.tb00031.x.
To evaluate the homogeneity of patients operated on for MTLE.
30 consecutive patients prospectively investigated with clinical, EEG, neuropsychology, MRI, FDG-PET criteria and eventually intracranial EEG, who underwent antero-medial temporal resection (follow-up: 24 months).
Clear and well-lateralised MTLE was non-invasively ascertained in 22 patients (73%). Eight patients (27%) had a less pure presentation due to divergent scalp EEG features (bitemporal, widespread or extratemporal), unusual auras or absence of MRI-based hippocampal sclerosis or FDG-PET hypometabolism. They were explored by invasive monitoring which confirmed medial temporal origin of seizures. Outcome was excellent in 95% of the pure cases (Engel's class I) and less favorable in the more difficult ones (65% of class I).
MTLE criteria, including the strong contribution of brain imaging, permit to select accurately a large percentage of patients. However a consistant number of patients present a less pure presentation suggesting more complex epileptogenic networks.
评估接受内侧颞叶癫痫（MTLE）手术治疗患者的同质性。
对30例连续患者进行前瞻性研究，采用临床、脑电图（EEG）、神经心理学、磁共振成像（MRI）、氟代脱氧葡萄糖正电子发射断层扫描（FDG-PET）标准，最终采用颅内EEG，这些患者均接受了前内侧颞叶切除术（随访：24个月）。
22例患者（73%）通过非侵入性检查明确诊断为典型且定位明确的MTLE。8例患者（27%）表现不典型，原因包括头皮EEG特征分散（双侧颞叶、广泛或颞叶外）、发作先兆异常或缺乏基于MRI的海马硬化或FDG-PET代谢减低。对这些患者进行了侵入性监测，证实癫痫发作起源于内侧颞叶。95%的典型病例预后良好（Engel分级I级），而情况较复杂的患者预后较差（I级患者占65%）。
MTLE的诊断标准，包括脑成像的重要作用，能够准确筛选出大部分患者。然而，仍有相当数量的患者表现不典型，提示癫痫发生网络更为复杂。
