背景:与海马硬化相关的颞叶癫痫(TLE-HS)是一种可手术治疗的癫痫综合征。虽然术前评估的核心依赖于视频脑电图,最近的研究质疑记录癫痫发作的必要性,否认发作脑电图在手术决策中的可能作用。本研究旨在回顾性评估脑电图发作模式在TLE-HS中的预后价值。为了确定哪些患者在提供手术前需要进一步检查。
方法:我们纳入了接受手术的TLE-HS患者,在非侵入性手术前视频脑电图记录期间至少有一次癫痫发作。它们分为“中间”和“横向/混合”,根据脑电图模式,由放电频率定义(mesial≥5Hz,横向<5Hz)。癫痫发作结果由Engel'sClass进行评估。进行统计分析以评估EEG模式与手术后结果之间的关联。
结果:69显示出中等程度的模式,四十二显示横向/混合模式。Mesial模式组的术后癫痫发作自由度明显更高(82.7%vs.28.6%)。性别,发病年龄,手术年龄,癫痫的持续时间,癫痫发作频率,和偏侧化并不影响结果。中期模式与有利结果显著相关(p<0.001),表明其潜在的预测价值。
结论:这项回顾性研究提出了脑电图模式作为TLE-HS术后预后的可能预测因子。中等模式与更好的结果相关,表明一个潜在的更有限的癫痫发生区。具有侧向/混合模式的患者可能会受益于其他研究以描绘癫痫发生区。需要进一步的研究来验证和扩展这些发现。
BACKGROUND: Temporal lobe epilepsy associated with hippocampal sclerosis (TLE-HS) is a surgically treatable epileptic syndrome. While the core of pre-surgical evaluations rely on video-EEG, recent studies question the necessity of recorded seizures denying a possible role of ictal EEG in surgical decision. This study aims to retrospectively assess the prognostic value of EEG ictal patterns in TLE-HS, in order to identify which patients need further investigations before offering surgery.
METHODS: We included TLE-HS patients who underwent surgery with at least one captured seizure during non-invasive pre-surgical video-EEG recordings. They were classified in \"mesial\" and \"lateral/mixed\", according to the ictal EEG patterns, defined by the frequency of the discharge (mesial ≥ 5 Hz, lateral < 5 Hz). Seizure outcome was assessed by Engel\'s Class. Statistical analyses were performed to evaluate associations between EEG patterns and post-surgical outcomes.
RESULTS: Sixty-nine exhibited a mesial pattern, forty- two displayed lateral/mixed patterns. Mesial pattern group had a significantly higher rate of postsurgical seizure freedom (82.7% vs. 28.6%). Gender, age of onset, age at surgery, duration of epilepsy, seizure frequency, and lateralization did not influence the outcome. Mesial pattern significantly correlated with favorable outcomes (p < 0.001), suggesting its potential predictive value.
CONCLUSIONS: This retrospective study proposes ictal EEG patterns as possible predictors of postoperative prognosis in TLE-HS. A mesial pattern correlates with better outcomes, indicating a potentially more circumscribed epileptogenic zone. Patients with lateral/mixed patterns may benefit from additional investigations to delineate the epileptogenic zone. Further studies are warranted to validate and extend these findings.