| 비병변성 신피질 측두엽 간질의 수술적 절제술의 예후 |
| 이 승헌, 정 원영, Steven V. Pacia* |
| 조선대학교 의과대학 신경과학 교실, 뉴욕대학병원 포괄적 간질센타* |
| Outcome of Resective Surgery
for Non-lesional Neocortical Temporal Lobe Epilepsy |
| Seung Heon Lee, M.D., Won Young Jung, M.D., Steven V. Pacia, M.D.* |
| Department of Neurology, Chosun University Medical College,
Comprehensive Epilepsy Center, New York University Hospital, New York, N.Y., U.S.A.* |
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| Abstract |
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Background : Patients with neocortical temporal lobe epilepsy(NTLE) are reported to have less
favorable outcome with anterior temporal lobectomy, and the prognostic factors for patients with
non-lesional NTLE are not well defined. Methods : We analyzed the multiple potential predictors of
outcome for 26 consecutive medically intractable non-lesional NTLE patients who have had both
extracranial and intracranial EEG monitoring during their presurgical evaluation prior to surgery:
age, age at seizure onset, sex, seizure semiology, seizure duration and frequency, an etiology, the
site of the surgery, the region of intracranial ictal onset, intracranial amobarbital procedure,
neuropsychology test, neuroimaging, multiple subpial transection(MST) and surgical pathology. The
average follow up period was 37.0±11.1(range 20-60) months. The outcome factors analyzed were
compared to two types of outcome group; seizure free group(class I) and persistent seizure
group(class II-IV) according to Engel's classification. Results : Seventeen of 26 non-lesional NTLE
patients(65.4%) were seizure free during follow up. Intracranial ictal onset confined to anterior
temporal region only significantly predicted seizure free(p<0.001). Earlier seizure onset(p=0.08) and
resection without MST(p=0.10) tended to be seizure free, but not statistically significant.
Conclusion : Patients with non-lesional NTLE can be a good candidate for a tailored anterior
temporal neocorticectomy with/without MST after intracranial EEG monitoring and functional
mapping.
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Key words : non-lesional neocortical temporal lobe epilepsy, anterior temporal lobectomy,
prognostic factors
Background : Patients with neocortical temporal lobe epilepsy(NTLE) are reported to have less
favorable outcome with anterior temporal lobectomy, and the prognostic factors for patients with
non-lesional NTLE are not well defined. Methods : We analyzed the multiple potential predictors of
outcome for 26 consecutive medically intractable non-lesional NTLE patients who have had both
extracranial and intracranial EEG monitoring during their presurgical evaluation prior to surgery:
age, age at seizure onset, sex, seizure semiology, seizure duration and frequency, an etiology, the
site of the surgery, the region of intracranial ictal onset, intracranial amobarbital procedure,
neuropsychology test, neuroimaging, multiple subpial transection(MST) and surgical pathology. The
average follow up period was 37.0±11.1(range 20-60) months. The outcome factors analyzed were
compared to two types of outcome group; seizure free group(class I) and persistent seizure
group(class II-IV) according to Engel's classification. Results : Seventeen of 26 non-lesional NTLE
patients(65.4%) were seizure free during follow up. Intracranial ictal onset confined to anterior
temporal region only significantly predicted seizure free(p<0.001). Earlier seizure onset(p=0.08) and
resection without MST(p=0.10) tended to be seizure free, but not statistically significant.
Conclusion : Patients with non-lesional NTLE can be a good candidate for a tailored anterior
temporal neocorticectomy with/without MST after intracranial EEG monitoring and functional
mapping.
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Key words : non-lesional neocortical temporal lobe epilepsy, anterior temporal lobectomy,
prognostic factors |
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