药物耐药性中发作结果在多微症的设置中
Thandar Aung1, Jin Bo2, William Bingaman3
1Epilepsy Center, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk S60, Cleveland, OH 44195, United States; University of Pittsburgh Epilepsy Center, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
与多微症 (PMG) 相关的耐药性 (DRE) 的内电脑图 (ICEEG) 引导手术改善了的自由度. 确定PMG内部或外部的发性区域 (EZ) 是成功手术结果的关键.
科学领域:
- 神经科学是一个神经科学.
- 发病学 (Epileptology) 是一个专业的学科.
- 神经外科 神经外科
背景情况:
- 多微症 (PMG) 是一种与耐药性 (DRE) 相关的皮质形.
- 在PMG相关的DRE中定义精确的发性区域 (EZ) 是一个挑战,影响手术规划和结果.
- 内电脑图 (ICEEG) 提供了详细的内发病局部化.
研究的目的:
- 分析PMG相关DRE患者的发作结果.
- 用ICEEG来定义ictal发作,考虑到周围的皮质和外科切除程度.
- 在这个患者群体中确定发作自由 (SF) 的预测因子.
主要方法:
- 对35名PMG相关DRE患者 (2001-2018) 的回顾性研究.
- 主要结局:通过恩格尔分类 (≥1年随访) 完全无 (SF).
- 用于确定预测性临床变量的单变量和多变量考克斯比例危险模型.
主要成果:
- 在手术组 (n=23) 中,52%的人达到SF,而非切除组 (n=12) (p=0.002) 中为0% (p=0.002).
- 根据PMG横向性,形参与或切除程度 (总和部分) 的依据,发作自由度没有显著差异.
- 患有PMG和非PMG皮层或仅非PMG皮层中阴道发病的患者比仅在PMG皮层中发病的患者有更好的SF机会.
结论:
- 在PMG相关的DRE中以ICEEG为导向的EZ定义的切除性手术导致了有利的发作结果.
- 即使在复杂的PMG病例 (双边或广泛的单边) 中,ICEEG引导的焦点切除也可以实现SF.
- 完全切除MRI可见的PMG并不能保证SF;基于发性网络评估的植入前假设开发至关重要.
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