ABSTRACT

Objective: The aim of this retrospective cohort study was to assess seizure and memory outcomes following temporal lobe surgery in patients suffering from medically refractory temporal lobe epilepsy (TLE) and hippocampal sclerosis (HS).

Methods: A retrospective monocentric data analysis was performed in consecutive patients who were operated on during 2002–2018. In the first decennium, standard temporal lobe resections (TLR) were predominately performed, and later, antero-temporal lobe resections (ATLR) were mainly performed. Seizure and memory outcomes over time were assessed according to ILAE/Engel classification and the Berlin Amnesia Test (BTA), respectively.

Results: Altogether, 231 surgeries were performed on 226 patients (mean age, 40 years [range, 10–68 years]; male: female, 1:1.4; mean seizure duration, 25 years; and mean follow-up duration, 4.75 years [range, 1–16]). Recently, outcomes of 78.3% of the patients in the total cohort were classified as Engel class I, with 54.9% of patients being completely seizure free. The recent cohort of ATLR since 2012 showed significant more completely seizure-free patients than before 2012 (Engel IA 46.6% versus 67.7%, p < 0.0025, χ²), although the Kaplan Meier analysis of all patients favors TLR for better seizure outcome (61% ATLR vs 73% TLR seizure free after 5 yrs, log rank p < 0.001). Verbal memory improved significantly in non-dominant patients. Minor neurological complications were noted (permanent severe complications, 0.4%; temporary severe complications, 4.8%).

Conclusion: Significant improvements in seizure and memory outcomes were observed over time, with surgical technique and seizure duration as important prognostic factors. Early admittance for surgery may favor an excellent seizure outcome in patients undergoing temporal lobe resection for HS.

摘要

目的：这项回顾性队列研究的目的是评估药物难治性颞叶癫痫 (TLE) 和海马硬化 (HS) 患者颞叶手术后的癫痫发作和记忆结果。

方法：对 2002-2018 年接受手术的连续患者进行回顾性单中心数据分析。在第一个十年，主要进行标准颞叶切除术（TLR），后来主要进行前颞叶切除术（ATLR）。随着时间的推移，癫痫发作和记忆结果分别根据 ILAE/Engel 分类和柏林健忘症测试 (BTA) 进行评估。

结果：总共对 226 名患者进行了 231 次手术（平均年龄，40 岁 [范围，10-68 岁]；男性：女性，1:1.4；平均癫痫发作时间，25 年；平均随访时间，4.75 年[范围，1-16]）。最近，整个队列中 78.3% 的患者的结局被归类为 Engel I 级，其中 54.9% 的患者完全没有癫痫发作。自 2012 年以来的最新 ATLR 队列显示，与 2012 年之前相比，完全无癫痫发作的患者显着增加（Engel IA 46.6% 对 67.7%，p < 0.0025，χ ²)，尽管对所有患者的 Kaplan Meier 分析都支持 TLR 以获得更好的癫痫发作结果（61% ATLR vs 73% TLR 在 5 年后无癫痫发作，对数秩 p < 0.001）。非优势患者的语言记忆显着改善。注意到轻微的神经系统并发症（永久性严重并发症，0.4%；暂时性严重并发症，4.8%）。

结论：随着时间的推移，观察到癫痫发作和记忆结果的显着改善，手术技术和癫痫发作持续时间是重要的预后因素。早期接受手术可能有利于接受颞叶切除术的 HS 患者获得良好的癫痫发作结果。