Absolute spike frequency and etiology predict the surgical outcome in epilepsy due to amygdala lesions

作者：Gyimesi Csilla; Pannek Heinz; Woermann Friedrich G; Elsharkawy Alaa Eldin; Tomka Hoffmeister Maria; Hortsmann Simone; Aengenendt Joerg; Horvath Reka A; Schulz Reinhard; Hoppe Matthias; Janszky Jozsef; Ebner Alois^*

来源：Epilepsy Research, 2010, 92(2-3): 177-182.

DOI：10.1016/j.eplepsyres.2010.09.005

• Epilepsy surgery prognosis
• Spike frequency
• Amygdala
• Familial epilepsy
• Apical temporal lobe resection

Purpose: To identify surgical prognostic factors for temporal lobe epilepsy (TLE) due to amygdala lesions.
Methods: We included 42 patients (mean age: 31.4 +/- 11) who underwent presurgical evaluation including long-term video-EEG and in whom the high-resolution MRI showed amygdala lesions without hippocampal abnormalities. All patients had apical temporal lobe resection without hippocampectomy. We distinguished patients with frequent spikes (spike frequency >= 60/h) and with non-frequent spikes (<60 spikes/h).
Results: At the 2-year postoperative evaluation, 30 patients (71%) were seizure-free. The presence of infrequent spikes (p=0.013), tumor on the MRI (p=0.027), and no epilepsy history in the family (p=0.027) were independently associated with 2-year seizure-free outcome. Of 33 patients with infrequent spikes, 79% became seizure-free, while of 9 patients with frequent spikes only 4 had a favorable surgical outcome (44%).
Conclusion: In TLE patients due to amygdala lesions, high spike frequency and family history of epilepsy predicted an unfavorable, while tumoral etiology a favorable outcome after apical temporal lobe resection without hippocampectomy. Seventy-one percent of patients with amygdalar epilepsy who underwent this novel type of epilepsy surgery became seizure-free. This is comparable with results of "classical" anterior temporal lobe resections where hippocampus is NOT spared. Moreover, the surgical outcome may be predictable.

• 出版日期2010-12