Sirven J I, Malamut B L, Liporace J D, O'Connor M J, Sperling M R
Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University Hospital, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA.
Ann Neurol. 1997 Dec;42(6):873-8. doi: 10.1002/ana.410420608.
We determined how noninvasive presurgical data relate to prognosis after temporal lobectomy in patients with independent bilateral temporal lobe (IBTL) complex partial seizures on the intracranial electroencephalogram (EEG). Between 1986 and 1994, 28 patients had IBTL seizures on intracranial EEG. Fifteen of these 28 patients underwent temporal lobectomy and 13 were not offered surgery. Of the 15 patients who had surgery, 10 patients became seizure-free. Magnetic resonance imaging (MRI) and the Wada test were the only variables associated with a seizure-free outcome. Seven of 10 seizure-free patients had a lateralized Wada result or the presence of unilateral hippocampal sclerosis, whereas none of the patients with persistent seizures had either of these findings. Variables not found to be predictive of a seizure-free outcome included location of scalp interictal spikes, degree of seizure-onset laterality, presence of early epilepsy risk factor, duration of epilepsy, and full-scale intelligence quotient. We conclude that MRI and the Wada test provide information of prognostic value in patients with bilateral temporal seizures independent of intracranial EEG data.
我们确定了颅内脑电图（EEG）显示独立双侧颞叶（IBTL）复杂部分性发作的患者，术前非侵入性数据与颞叶切除术后预后的关系。1986年至1994年间，28例患者颅内EEG显示有IBTL发作。这28例患者中有15例接受了颞叶切除术，13例未接受手术。在接受手术的15例患者中，10例患者术后无癫痫发作。磁共振成像（MRI）和Wada试验是与无癫痫发作结果相关的唯一变量。10例无癫痫发作的患者中有7例Wada试验结果呈单侧化或存在单侧海马硬化，而持续有癫痫发作的患者均无上述表现。未发现可预测无癫痫发作结果的变量包括头皮发作间期棘波的位置、癫痫发作起始的偏侧程度、早期癫痫危险因素的存在、癫痫持续时间和全量表智商。我们得出结论，MRI和Wada试验可为双侧颞叶癫痫患者提供独立于颅内EEG数据的预后价值信息。
