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Abstract：
BACKGROUND: We aimed to analyze potentially prognostic factors which could have influence on postoperative seizure, neuropsychological and psychiatric outcome in a cohort of patients with mesial temporal lobe epilepsy (MTLE) due to hippocampal sclerosis (HS) after selective amygdalohippocampectomy (SAHE) via transsylvian approach.
METHODS: Clinical variables of 171 patients with drug-resistant MTLE with HS (88 females) who underwent SAHE between 1994 and 2019 were evaluated using univariable and multivariable logistic regression models, to investigate which of the explanatory parameters can best predict the outcome.
RESULTS: At the last available follow-up visit 12.3 ± 6.3 years after surgery 114 patients (67.9%) were seizure-free. Left hemispheric MTLE was associated with worse postoperative seizure outcome at first year after surgery (OR = 0.54, p = 0.01), female sex-with seizure recurrence at years 2 (OR = 0.52, p = 0.01) and 5 (OR = 0.53, p = 0.025) and higher number of preoperative antiseizure medication trials-with seizure recurrence at year 2 (OR = 0.77, p = 0.0064), whereas patients without history of traumatic brain injury had better postoperative seizure outcome at first year (OR = 2.08, p = 0.0091). All predictors lost their predictive value in long-term course. HS types had no prognostic influence on outcome. Patients operated on right side performed better in verbal memory compared to left (VLMT 1-5 p < 0.001, VLMT 7 p = 0.001). Depression occurred less frequently in seizure-free patients compared to non-seizure-free patients (BDI-II Z = - 2.341, p = 0.019).
CONCLUSIONS: SAHE gives an improved chance of achieving good postoperative seizure, psychiatric and neuropsychological outcome in patients with in MTLE due to HS. Predictors of short-term outcome don\'t predict long-term outcome.
METHODS: Clinical variables of 171 patients with drug-resistant MTLE with HS (88 females) who underwent SAHE between 1994 and 2019 were evaluated using univariable and multivariable logistic regression models, to investigate which of the explanatory parameters can best predict the outcome.
RESULTS: At the last available follow-up visit 12.3 ± 6.3 years after surgery 114 patients (67.9%) were seizure-free. Left hemispheric MTLE was associated with worse postoperative seizure outcome at first year after surgery (OR = 0.54, p = 0.01), female sex-with seizure recurrence at years 2 (OR = 0.52, p = 0.01) and 5 (OR = 0.53, p = 0.025) and higher number of preoperative antiseizure medication trials-with seizure recurrence at year 2 (OR = 0.77, p = 0.0064), whereas patients without history of traumatic brain injury had better postoperative seizure outcome at first year (OR = 2.08, p = 0.0091). All predictors lost their predictive value in long-term course. HS types had no prognostic influence on outcome. Patients operated on right side performed better in verbal memory compared to left (VLMT 1-5 p < 0.001, VLMT 7 p = 0.001). Depression occurred less frequently in seizure-free patients compared to non-seizure-free patients (BDI-II Z = - 2.341, p = 0.019).
CONCLUSIONS: SAHE gives an improved chance of achieving good postoperative seizure, psychiatric and neuropsychological outcome in patients with in MTLE due to HS. Predictors of short-term outcome don\'t predict long-term outcome.
摘要：
背景：我们旨在分析可能影响术后癫痫发作的潜在预后因素，通过跨侧裂入路选择性杏仁核海马切除术（SAHE）后，由于海马硬化（HS）引起的内侧颞叶癫痫（MTLE）患者队列的神经心理学和精神病学结局。
方法：使用单变量和多变量logistic回归模型评估了1994年至2019年间接受SAHE的171例耐药MTLE合并HS患者（88例女性）的临床变量，调查哪一个解释参数可以最好地预测结果。
结果：在手术后12.3±6.3年的最后一次随访中，114例患者（67.9％）无癫痫发作。左半球MTLE在术后第一年与更差的术后癫痫发作结果相关(OR=0.54,p=0.01),女性性别-在第2年（OR=0.52，p=0.01）和第5年（OR=0.53，p=0.025）复发，术前抗癫痫药物试验次数较多-在第2年（OR=0.77，p=0.0064），而没有创伤性脑损伤病史的患者在第一年的术后癫痫发作结局更好(OR=2.08,p=0.0091).所有预测因子在长期过程中都失去了预测价值。HS类型对预后无影响。与左侧相比，右侧手术的患者在言语记忆方面表现更好（VLMT1-5p<0.001，VLMT7p=0.001）。与无癫痫患者相比，无癫痫患者的抑郁症发生率较低（BDI-IIZ=-2.341，p=0.019）。
结论：SAHE改善了术后癫痫发作的机会，HS引起的MTLE患者的精神病学和神经心理学结局。短期结果的预测因素不能预测长期结果。
方法：使用单变量和多变量logistic回归模型评估了1994年至2019年间接受SAHE的171例耐药MTLE合并HS患者（88例女性）的临床变量，调查哪一个解释参数可以最好地预测结果。
结果：在手术后12.3±6.3年的最后一次随访中，114例患者（67.9％）无癫痫发作。左半球MTLE在术后第一年与更差的术后癫痫发作结果相关(OR=0.54,p=0.01),女性性别-在第2年（OR=0.52，p=0.01）和第5年（OR=0.53，p=0.025）复发，术前抗癫痫药物试验次数较多-在第2年（OR=0.77，p=0.0064），而没有创伤性脑损伤病史的患者在第一年的术后癫痫发作结局更好(OR=2.08,p=0.0091).所有预测因子在长期过程中都失去了预测价值。HS类型对预后无影响。与左侧相比，右侧手术的患者在言语记忆方面表现更好（VLMT1-5p<0.001，VLMT7p=0.001）。与无癫痫患者相比，无癫痫患者的抑郁症发生率较低（BDI-IIZ=-2.341，p=0.019）。
结论：SAHE改善了术后癫痫发作的机会，HS引起的MTLE患者的精神病学和神经心理学结局。短期结果的预测因素不能预测长期结果。
