Czynniki prognostyczne wyników napadów padaczkowych i jakości życia pacjentów po chirurgicznym leczeniu padaczki skroniowej
Predictors of long-term seizure outcomes and perceived quality of life outcomes after temporal lobe epilepsy surgery
W skrócie
Badanie wykazało, że u ponad 83% pacjentów poddanych operacji ze względu na padaczkę skroniową osiągnięto całkowite ustąpienie napadów przez ponad 4 lata obserwacji, a około 75% pacjentów odczuło znaczną poprawę jakości życia. Ważne okazało się to, że u pacjentów z tzw. czerwonymi flagami (sygnałami ostrzegawczymi) szanse na całkowite wyleczenie były znacznie mniejsze, a zachowanie części mózgu odpowiedzialnej za pamięć w pewnych typach padaczki nie zawsze skutkowało lepszymi wynikami neuropsychologicznymi.
Oryginalny abstract (angielski)
BACKGROUND: Balancing seizure outcomes and cognitive deficits is always a challenge in both mesial and neocortical temporal lobe epilepsy cohorts. The present study evaluated the long-term seizure outcomes and perceived quality of life (QOL) in both of these groups, along with factors predictive of these outcomes. METHODS: A retrospective analysis of patients undergoing temporal lobe epilepsy (TLE) surgery from 2015 to 2023, with at least 1 year of follow-up (N = 175), is presented. Patients were grouped as MTLE (mesial temporal sclerosis only) and NTLE (neocortical) based on neuroimaging. Surgical approaches included standard anterior temporal lobectomy with amygdalohippocampectomy (ATL + AH) and hippocampal-sparing resections. Seizure outcomes were classified using Engel's scale; QOL was assessed telephonically using a questionnaire adopted from QOLIE-10-P. Predictors for seizure freedom and perceived QOL outcomes were studied in both groups. RESULTS: At a mean follow-up of 55 months, 83.5% of patients achieved seizure freedom, MTLE (85%), and NTLE (81%) patients. Of the entire TLE cohort, 38% were free from drugs at the last follow-up. In MTLE, the presence of red flags significantly lowers the chances of complete seizure freedom (59% vs. 93%.) (OR 0.11, 95% CI 0.03-0.37; p < 0.001). Preserving the hippocampus in NTLE is associated with a lower the seizure freedom rate (68% vs. 86%) (OR 0.34, 95% CI 0.10-1.08). In NTLE, the odds of perceived memory decline were marginally higher in the standard ATL + AH group (OR 1.48, 95% CI 0.37-5.87) compared to hippocampus-preserving resection (p = 0.7). Approx. 75% patients reported improvement in all QOL parameters in the entire TLE cohort. No mortality or permanent neurological deficits recorded. CONCLUSIONS: TLE surgery provides robust seizure control and significant perceived QOL improvements for most patients in the long term. Hippocampal sparing surgery in NTLE did not seem to affect perceived memory difficulties but was more likely to be associated with suboptimal seizure outcomes.