Długoterminowa wartość prognostyczna wczesnego pooperacyjnego badania EEG u pacjentów z oporną na leki epilepsją płata skroniowego związaną ze stwardnieniem hipokampu
Long-term prognostic value of early post-operative electroencephalogram in patients with drug-resistant temporal lobe epilepsy associated with hippocampal sclerosis
W skrócie
Badanie wykazało, że u pacjentów poddanych operacji z powodu opornej na leki epilepsji płata skroniowego ze stwardnieniem hipokampu, obecność wysokoczęstotliwych nieprawidłowych wyładowań elektrycznych w mózgu na wczesnym badaniu EEG po operacji wiąże się z gorszymi wynikami w dłuższej perspektywie czasowej. Natomiast niska częstotliwość tych wyładowań lub ich brak nie wskazywały na pogorszenie stanu pacjenta, a większość pacjentów (78 procent) była wolna od napadów przez rok po zabiegu.
Oryginalny abstract (angielski)
PURPOSE: Surgery is the treatment of choice for drug-resistant temporal lobe epilepsy (TLE) associated with hippocampal sclerosis (HS). We assessed whether interictal epileptiform discharges (IEDs) on early postoperative EEG predicted seizure outcome after surgery. METHODS: We retrospectively included consecutive patients aged >16 years who underwent surgery for drug-resistant TLE with pathologically confirmed HS at Pitié-Salpêtrière Hospital, Paris, between 2003 and 2023. Eligible patients had at least 1 year of follow-up and an early postoperative EEG performed within 1 month after surgery. IED frequency was classified as high frequency (≥1/min) or low frequency (<1/min). Favourable 1-year outcome was defined as ILAE class 1. Long-term worsening was defined as any increase in ILAE class after the 1-year visit. RESULTS: Among 168 patients, 131 (78.0%) were ILAE class 1 at 1 year. EEG was performed a median of 7 days after surgery. IEDs were present in 81 patients (48.2%), including 48 with low-frequency and 33 with high-frequency IEDs. EEG features, including IED presence and frequency, did not differ between patients with and without ILAE class 1 outcome at 1 year. During longer follow-up, high-frequency IEDs were associated with worsening compared with no IEDs in the whole cohort (HR 2.25, 95% CI 1.01-4.98; p=0.046) and among patients seizure-free at 1 year (HR 2.59, 95% CI 1.10-6.11; p=0.03). Low-frequency IEDs were not associated with worsening. CONCLUSION: High-frequency IEDs on early postoperative EEG may identify patients at increased risk of long-term deterioration after surgery for HS-related TLE. Prospective studies are needed before modifying routine follow-up strategies.