Radhakrishnan K, So E L, Silbert P L, Jack C R, Cascino G D, Sharbrough F W, O'Brien P C
Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA.
Neurology. 1998 Aug;51(2):465-71. doi: 10.1212/wnl.51.2.465.
To identify presurgical and postsurgical factors that are independently predictive of the outcome of anterior temporal lobectomy (ATL) for intractable epilepsy.
There have been reports of prognostic factors in epilepsy surgery, but little is known about factors that independently predict outcome of ATL.
We studied 175 consecutive ATL patients who had at least 2 years of postsurgical follow-up. Significant factors on univariate analyses were subjected to stepwise logistic regression analysis.
On univariate analyses, two presurgical conditions were significantly associated with excellent seizure control at last follow-up: (1) unilateral hippocampal formation atrophy as detected on MRI and (2) all scalp interictal epileptiform discharges concordant with the location of ictal onset (p < 0.05). Three postsurgical factors that occurred during the first year were associated with excellent seizure outcome: the absence of interictal epileptiform discharges at 3 months, complete seizure control, and having only nondisabling seizures for those who did not become seizure free. Logistic regression analysis revealed the following to be independently predictive of excellent seizure control: MRI-detected unilateral hippocampal formation atrophy, concordant interictal epileptiform discharges, complete seizure control during the first postsurgical year, and having only nondisabling seizures during the first postsurgical year for those who did not become seizure free.
Presurgical identification of unilateral hippocampal formation atrophy, or of interictal epileptiform discharges that are all concordant with the location of ictal onset, predict excellent outcome of ATL. However, the probability of excellent outcome is highest (94%) when both factors are present.
确定独立预测难治性癫痫患者前颞叶切除术(ATL)预后的术前及术后因素。
已有关于癫痫手术预后因素的报道,但对于独立预测ATL预后的因素知之甚少。
我们研究了175例连续接受ATL手术且术后至少随访2年的患者。单因素分析中有显著意义的因素进行逐步逻辑回归分析。
单因素分析中,两个术前情况与末次随访时癫痫发作得到良好控制显著相关:(1)MRI检测到单侧海马结构萎缩;(2)所有头皮发作间期癫痫样放电与发作起始部位一致(p<0.05)。术后第一年出现的三个因素与癫痫发作良好预后相关:术后3个月无发作间期癫痫样放电、癫痫发作完全控制,以及对于未实现无发作的患者仅有非致残性发作。逻辑回归分析显示,以下因素可独立预测癫痫发作得到良好控制:MRI检测到的单侧海马结构萎缩、一致的发作间期癫痫样放电、术后第一年癫痫发作完全控制,以及对于未实现无发作的患者术后第一年仅有非致残性发作。
术前识别单侧海马结构萎缩或所有与发作起始部位一致的发作间期癫痫样放电,可预测ATL的良好预后。然而,当两个因素都存在时,良好预后的概率最高(94%)。