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Neurology:药物难治性癫痫患者脑电评估后预后的预测因素

2022-06-15 Naomi MedSci原创

近日,一项发表在Neurology的研究试图确定手术切除和随后的颅内脑电图(ICEEG)后癫痫缓解的预测因素。研究表明病变MRI的存在,术前假说提示颞叶开始,以及非优势半球植入是手术切除独立预测因素。

尽管出现了几种新的抗癫痫药物(ASM),但医学上难治性癫痫发作的患者比例保持在约30%。当来自非侵入性研究的信息不充分或不一致时,或表明可能与需要额外定位信息的不可或缺的功能脑区共同定位时,尤其是在有非病变MRI的患者中,或在切除手术前需要详细的清醒皮质刺激标测时,通过植入电极的术中颅内脑电记录(ICEEG)被提示。近日,一项发表在Neurology上的研究试图确定手术切除和随后的颅内脑电图(ICEEG)后癫痫缓解的预测因素,用于癫痫发作的定位。

方法:

回顾2002-2015年间连续接受ICEEG监测的178例难治性癫痫患者的临床资料。单变量和多变量回归分析确定了与其他选择相比切除的独立预测因素。采用逐步Akaike‘s信息标准(AIC)并辅以临床考虑,选择最佳的多变量模型预测手术切除和预后。采用离散时间生存分析方法,分析影响癫痫解除预后的因素。用Kaplan-Meier曲线分析癫痫发作自由的累积概率,并比较切除组和未切除组之间的差异。对癫痫手术评估中常见的8种临床方案进行了额外的单变量分析。

结果:

  • 多变量分析显示病变磁共振、术前假说提示颞叶病变、非优势半球植入是手术切除的独立预测因素(p<0.0001,AUC0.80,CI0.73-0.87)。
  • 局灶性ICEEG发作和接受切除手术预测在五年的随访中癫痫发作完全缓解。与继续内科治疗或神经调节治疗相比,接受切除手术的患者5年后癫痫发作消失的可能性更大(60%比7%;P<0.0001,HR0.16,95%CI,0.09~0.28)。
  • 即使患者被认为有不利的预测因素(非皮损核磁共振或颞叶外假说或优势半球植入),如果他们接受切除,在5年内有50%的癫痫发作缓解的机会。

解释:不利的预测因素,包括有非损伤性的颞外癫痫,不应该阻止手术前的彻底评估,包括许多有侵入性的记录。无功能损害的切除手术为持续的癫痫缓解提供了最好的机会,应该始终是第一位考虑的。

证据分类:这项研究提供了II类证据,表明病变MRI的存在,术前假说提示颞叶开始,以及非优势半球植入是手术切除的独立预测因素。局灶性颅内脑电发作和接受手术是5年癫痫发作自由的独立预测因素。

文献来源:Sivaraju A, Hirsch L, Gaspard N, et al. Factors Predicting Outcome After Intracranial EEG Evaluation in Patients With Medically Refractory Epilepsy [published online ahead of print, 2022May4]. Neurology. 2022;10.1212/WNL.0000000000200569. doi:10.1212/WNL.0000000000200569

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    2023-02-03 yinhl1978
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    2022-06-15 freve

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