海马硬化相关的颞叶癫痫的短期和长期手术预后：与神经病理学的关系_Journal of Epilepsy

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DeleoF , GarbelliR , MilesiG , 江欣玥 , 慕洁

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Keywords：

癫痫手术; 预后; 颞叶癫痫; 海马硬化

DOI：

10.7507/2096-0247.20170087

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海马硬化(Hippocampal sclerosis, HS)是接受手术治疗的难治性颞叶癫痫(Temporal lobe epilepsy, TLE)患者中最常见的病理类型。国际抗癫痫联盟(ILAE)最近按细胞丢失的不同类型提出一个新的HS分类。研究旨在探讨HS不同类型之间的关系、病因、有HS的耐药性TLE患者术后短期及长期预后。213例术后病理诊断为HS的患者纳入此研究，每例至少随访2年时间。患者依照ILAE标准进行HS分类，并进一步分为单纯HS(Isolated HS, IHS)、HS伴皮质发育不良(Focal cortical dysplasia, FCD IIIa)和HS伴其他病灶。将患者临床及病理特点与其以标准来评价的术后预后进行对比。主要发现如下：① 1型HS癫痫病程较长；② 80%以上患者短期和长期预后均在EngelⅠ级，无论何种HS类型和相关病理学改变；③短期和长期的术后预后在完全无癫痫发作的患者(EngelⅠa级)中较不令人满意，2型HS患者长期预后较1型更好；④无论HS为何种类型，伴有FCD的患者预后较差；⑤较短的癫痫持续时间与EngelⅠa级预后有显著关联。研究结果表明HS类型与相关病理改变能预测术后复发风险的重要因素，而其他变量如癫痫持续时间也需要考虑。公认的神经病理学分类标准有助于识别术前预测因素，并有助于筛选可能从癫痫手术中获益的患者。

Citation： DeleoF, GarbelliR, MilesiG, 江欣玥, 慕洁. 海马硬化相关的颞叶癫痫的短期和长期手术预后：与神经病理学的关系. Journal of Epilepsy, 2017, 3(6): 534-541. doi: 10.7507/2096-0247.20170087 Copy

1.	Bernasconi N, Bernasconi A, Caramanos Z, et al. Mesial temporal damage in temporal lobe epilepsy: A volumetric MRI study of the hippocampus, amygdala and parahippocampal region. Brain, 2003, 126(Pt 2): 462-469.
2.	Bernasconi A. Magnetic resonance imaging in intractable epilepsy: focus on structural image analysis. Adv Neurol, 2006, 97: 273-278.
3.	Sommer W. Erkrankung des Ammonshornsalsaetiologisches Moment der Epilepsie. Arch PsychiatrNervenkr, 1980, 10: 631-675.
4.	Margerison JH, Corsellis JA. Epilepsy and the temporal lobes. A clinical, electroencephalographic and neuropathological study of the brain in epilepsy, with particular reference to the temporal lobes. Brain, 1966, 89(3): 499-530.
5.	Sagar HJ, Oxbury JM. Hippocampal neuron loss in temporal lobe epilepsy: correlation with early childhood convulsions. Ann Neurol, 1987, 22(3): 334-340.
6.	Bruton CJ. The neuropathology of temporal lobe epilepsy. Oxford: Oxford University Press, 1988.
7.	Meencke HJ, Veith G. Hippocampal sclerosis in epilepsy. In Luders HO (Ed) Epilepsy surgery. New York, NY: Raven Press, 1991, 705-715.
8.	Wyler AR, Dohan FC, Schweitzer JB, et al. A grading system for mesial temporal pathology (hippocampal sclerosis) from anterior temporal lobectomy. J Epilepsy, 1992, 5(4): 220-225.
9.	Mathern GW, Pretorius JK, Babb TL. Quantified patterns of mossy fiber sprouting and neuron densities in hippocampal and lesional seizures. J Neurosurg, 1995, 82(2): 211-219.
10.	Meencke HJ, Veith G, Lund S. Bilateral hippocampal sclerosis and secondary epileptogenesis. Epilepsy Res Suppl, 1996, 12: 335-342.
11.	Proper EA, Jansen GH, van Veelen CW, et al. A grading system for hippocampal sclerosis based on the degree of hippocampal mossy fiber sprouting. Acta Neuropathol, 2001, 101(4): 405-409.
12.	deLanerolle NC, Kim JH, Williamson A, et al. A retrospective analysis of hippocampal pathology in human temporal lobe epilepsy: evidence for distinctive patient subcategories. Epilepsia, 2003, 44(5): 677-687.
13.	Thom M, Zhou J, Martinian L, et al. Quantitative post-mortem study of the hippocampus in chronic epilepsy: seizures do not inevitably cause neuronal loss. Brain, 2005, 128(Pt 6): 1344-1357.
14.	Blumcke I, Pauli E, Clusmann H, et al. A new clinico-pathological classification system for mesial temporal sclerosis. Acta Neuropathol, 2007, 113(3): 235-244.
15.	Thom M, Liagkouras I, Elliot KJ, et al. Reliability of patterns of hippocampal sclerosis as predictors of postsurgical outcome. Epilepsia, 2010, 51(9): 1801-1808.
16.	Blumcke I, Thom M, Aronica E, et al. International consensus classification of hippocampal sclerosis in temporal lobe epilepsy: A Task Force report from the ILAE Commission on Diagnostic Methods. Epilepsia, 2013, 54(7): 1315-1329.
17.	Wiebe S, Blume WT, Girvin JP, et al. A randomized, controlled trial of surgery for temporal-lobe epilepsy. N Engl J Med, 2001, 345(5): 311-318.
18.	Janszky J, Janszky I, Schulz R, et al. Temporal lobe epilepsy with hippocampal sclerosis: predictors for long-term surgical outcome. Brain, 2005, 128(Pt 2): 395-404.
19.	Tellez-Zenteno JF, Dhar R, Wiebe S. Long-term seizure outcomes following epilepsy surgery: A systematic review and meta-analysis. Brain, 2005, 128(Pt 5): 1188-1198.
20.	Aull-Watschinger S, Pataraia E, Czech T, et al. Outcome predictors for surgical treatment of temporal lobe epilepsy with hippocampal sclerosis. Epilepsia, 2008, 49(8): 1308-1316.
21.	Elsharkawy AE, Alabbasi AH, Pannek H, et al. Long-term outcome after temporal lobe epilepsy surgery in 434 consecutive adult patients. J Neurosurg, 2009, 110(6): 1135-1146.
22.	Jardim AP, Neves RS, Caboclo LO, et al. Temporal lobe epilepsy with mesial temporal sclerosis: hippocampal neuronal loss as A predictor of surgical outcome. Arq Neuropsiquiatr, 2012, 70(5): 319-324.
23.	Giulioni M, Marucci G, Martinoni M, et al. Seizure outcome in surgically treated drug-resistant mesial temporal lobe epilepsy based on the recent histopathological classifications. J Neurosurg, 2013, 119(1): 37-47.
24.	Coras R, Pauli E, Li J, et al. Differential influence of hippocampal subfields to memory formation: insights from patients with temporal lobe epilepsy. Brain, 2014, 137(Pt 7): 1945-1957.
25.	Savitr Sastri BV, Arivazhagan A, Sinha S, et al. Clinico-pathological factors influencing surgical outcome in drug resistant epilepsy secondary to mesial temporal sclerosis. J NeurolSci, 2014, 340(1-2): 183-190.
26.	Kwan P, Arzimanoglou A, Berg AT, et al. Definition of drug resistant epilepsy: consensus proposal by the ad hoc Task Force of the ILAE Commission on Therapeutic Strategies. Epilepsia, 2010, 51(6): 1069-1077.
27.	Guerrini R, Scerrati M, Rubboli G, et al. Overview of presurgical assessment and surgical treatment of epilepsy from the Italian League Against Epilepsy. Epilepsia, 2013, 54(Suppl 7): 35-48.
28.	Cossu M, Cardinale F, Castana L, et al. Stereoelectroencephalography in the presurgical evaluation of focal epilepsy: A retrospective analysis of 215 procedures. Neuro Surgery, 2005, 57(4): 706-718.
29.	Colombo N, Salamon N, Raybaud C, et al. Imaging of malformations of cortical development. Epileptic Disord, 2009, 11(3): 194-205.
30.	Engel JJ, Van Ness P, Rasmussen TB, et al. Outcome with respect to epileptic seizures. In Engel J (Ed) Surgical treatment of the epilepsies. New York, NY: Raven Press, 1993, 609-621.
31.	Garbelli R, Munari C, De Biasi S, et al. Taylor's cortical dysplasia: A confocal and ultrastructural immunohistochemical study. Brain Pathol, 1999, 9(3): 445-461.
32.	Blumcke I, Thom M, Aronica E, et al. The clinicopathologic spectrum of focal cortical dysplasias: A consensus classification proposed by an ad hoc task force of the ILAE diagnostic methods commission. Epilepsia, 2011, 52(1): 158-174.
33.	Sadek AR, Gray WP. Chopping and changing: long-term results of epilepsy surgery. Lancet, 2011, 378(9800): 1360-1362.
34.	Ramesha KN, Mooney T, Sarma PS, et al. Long-term seizure outcome and its predictors in patients with recurrent seizures during the first year after temporal lobe resective epilepsy surgery. Epilepsia, 2011, 52(5): 917-924.
35.	Wieser HG, Blume WT, Fish D, et al. ILAE Commission report. Proposal for A new classification of outcome with respect to epileptic seizures following epilepsy surgery. Epilepsia, 2001, 42(2): 282-286.
36.	Na M, Ge H, Shi C, et al. Long-term seizure outcome for international consensus classification of hippocampal sclerosis: A survival analysis. Seizure, 2015, 25: 141-146.
37.	Wang D, Blumcke I, Gui Q, et al. Clinico-pathological investigations of rasmussen encephalitis suggest multifocal disease progression and associated focal cortical dysplasia. Epileptic Disord, 2013, 15(1): 32-43.
38.	Garbelli R, Milesi G, Medici V, et al. Blurring in patients with temporal lobe epilepsy: clinical, high-field imaging and ultrastructural study. Brain, 2012, 135(Pt 8): 2337-2349.

1. Bernasconi N, Bernasconi A, Caramanos Z, et al. Mesial temporal damage in temporal lobe epilepsy: A volumetric MRI study of the hippocampus, amygdala and parahippocampal region. Brain, 2003, 126(Pt 2): 462-469.
2. Bernasconi A. Magnetic resonance imaging in intractable epilepsy: focus on structural image analysis. Adv Neurol, 2006, 97: 273-278.
3. Sommer W. Erkrankung des Ammonshornsalsaetiologisches Moment der Epilepsie. Arch PsychiatrNervenkr, 1980, 10: 631-675.
4. Margerison JH, Corsellis JA. Epilepsy and the temporal lobes. A clinical, electroencephalographic and neuropathological study of the brain in epilepsy, with particular reference to the temporal lobes. Brain, 1966, 89(3): 499-530.
5. Sagar HJ, Oxbury JM. Hippocampal neuron loss in temporal lobe epilepsy: correlation with early childhood convulsions. Ann Neurol, 1987, 22(3): 334-340.
6. Bruton CJ. The neuropathology of temporal lobe epilepsy. Oxford: Oxford University Press, 1988.
7. Meencke HJ, Veith G. Hippocampal sclerosis in epilepsy. In Luders HO (Ed) Epilepsy surgery. New York, NY: Raven Press, 1991, 705-715.
8. Wyler AR, Dohan FC, Schweitzer JB, et al. A grading system for mesial temporal pathology (hippocampal sclerosis) from anterior temporal lobectomy. J Epilepsy, 1992, 5(4): 220-225.
9. Mathern GW, Pretorius JK, Babb TL. Quantified patterns of mossy fiber sprouting and neuron densities in hippocampal and lesional seizures. J Neurosurg, 1995, 82(2): 211-219.
10. Meencke HJ, Veith G, Lund S. Bilateral hippocampal sclerosis and secondary epileptogenesis. Epilepsy Res Suppl, 1996, 12: 335-342.
11. Proper EA, Jansen GH, van Veelen CW, et al. A grading system for hippocampal sclerosis based on the degree of hippocampal mossy fiber sprouting. Acta Neuropathol, 2001, 101(4): 405-409.
12. deLanerolle NC, Kim JH, Williamson A, et al. A retrospective analysis of hippocampal pathology in human temporal lobe epilepsy: evidence for distinctive patient subcategories. Epilepsia, 2003, 44(5): 677-687.
13. Thom M, Zhou J, Martinian L, et al. Quantitative post-mortem study of the hippocampus in chronic epilepsy: seizures do not inevitably cause neuronal loss. Brain, 2005, 128(Pt 6): 1344-1357.
14. Blumcke I, Pauli E, Clusmann H, et al. A new clinico-pathological classification system for mesial temporal sclerosis. Acta Neuropathol, 2007, 113(3): 235-244.
15. Thom M, Liagkouras I, Elliot KJ, et al. Reliability of patterns of hippocampal sclerosis as predictors of postsurgical outcome. Epilepsia, 2010, 51(9): 1801-1808.
16. Blumcke I, Thom M, Aronica E, et al. International consensus classification of hippocampal sclerosis in temporal lobe epilepsy: A Task Force report from the ILAE Commission on Diagnostic Methods. Epilepsia, 2013, 54(7): 1315-1329.
17. Wiebe S, Blume WT, Girvin JP, et al. A randomized, controlled trial of surgery for temporal-lobe epilepsy. N Engl J Med, 2001, 345(5): 311-318.
18. Janszky J, Janszky I, Schulz R, et al. Temporal lobe epilepsy with hippocampal sclerosis: predictors for long-term surgical outcome. Brain, 2005, 128(Pt 2): 395-404.
19. Tellez-Zenteno JF, Dhar R, Wiebe S. Long-term seizure outcomes following epilepsy surgery: A systematic review and meta-analysis. Brain, 2005, 128(Pt 5): 1188-1198.
20. Aull-Watschinger S, Pataraia E, Czech T, et al. Outcome predictors for surgical treatment of temporal lobe epilepsy with hippocampal sclerosis. Epilepsia, 2008, 49(8): 1308-1316.
21. Elsharkawy AE, Alabbasi AH, Pannek H, et al. Long-term outcome after temporal lobe epilepsy surgery in 434 consecutive adult patients. J Neurosurg, 2009, 110(6): 1135-1146.
22. Jardim AP, Neves RS, Caboclo LO, et al. Temporal lobe epilepsy with mesial temporal sclerosis: hippocampal neuronal loss as A predictor of surgical outcome. Arq Neuropsiquiatr, 2012, 70(5): 319-324.
23. Giulioni M, Marucci G, Martinoni M, et al. Seizure outcome in surgically treated drug-resistant mesial temporal lobe epilepsy based on the recent histopathological classifications. J Neurosurg, 2013, 119(1): 37-47.
24. Coras R, Pauli E, Li J, et al. Differential influence of hippocampal subfields to memory formation: insights from patients with temporal lobe epilepsy. Brain, 2014, 137(Pt 7): 1945-1957.
25. Savitr Sastri BV, Arivazhagan A, Sinha S, et al. Clinico-pathological factors influencing surgical outcome in drug resistant epilepsy secondary to mesial temporal sclerosis. J NeurolSci, 2014, 340(1-2): 183-190.
26. Kwan P, Arzimanoglou A, Berg AT, et al. Definition of drug resistant epilepsy: consensus proposal by the ad hoc Task Force of the ILAE Commission on Therapeutic Strategies. Epilepsia, 2010, 51(6): 1069-1077.
27. Guerrini R, Scerrati M, Rubboli G, et al. Overview of presurgical assessment and surgical treatment of epilepsy from the Italian League Against Epilepsy. Epilepsia, 2013, 54(Suppl 7): 35-48.
28. Cossu M, Cardinale F, Castana L, et al. Stereoelectroencephalography in the presurgical evaluation of focal epilepsy: A retrospective analysis of 215 procedures. Neuro Surgery, 2005, 57(4): 706-718.
29. Colombo N, Salamon N, Raybaud C, et al. Imaging of malformations of cortical development. Epileptic Disord, 2009, 11(3): 194-205.
30. Engel JJ, Van Ness P, Rasmussen TB, et al. Outcome with respect to epileptic seizures. In Engel J (Ed) Surgical treatment of the epilepsies. New York, NY: Raven Press, 1993, 609-621.
31. Garbelli R, Munari C, De Biasi S, et al. Taylor's cortical dysplasia: A confocal and ultrastructural immunohistochemical study. Brain Pathol, 1999, 9(3): 445-461.
32. Blumcke I, Thom M, Aronica E, et al. The clinicopathologic spectrum of focal cortical dysplasias: A consensus classification proposed by an ad hoc task force of the ILAE diagnostic methods commission. Epilepsia, 2011, 52(1): 158-174.
33. Sadek AR, Gray WP. Chopping and changing: long-term results of epilepsy surgery. Lancet, 2011, 378(9800): 1360-1362.
34. Ramesha KN, Mooney T, Sarma PS, et al. Long-term seizure outcome and its predictors in patients with recurrent seizures during the first year after temporal lobe resective epilepsy surgery. Epilepsia, 2011, 52(5): 917-924.
35. Wieser HG, Blume WT, Fish D, et al. ILAE Commission report. Proposal for A new classification of outcome with respect to epileptic seizures following epilepsy surgery. Epilepsia, 2001, 42(2): 282-286.
36. Na M, Ge H, Shi C, et al. Long-term seizure outcome for international consensus classification of hippocampal sclerosis: A survival analysis. Seizure, 2015, 25: 141-146.
37. Wang D, Blumcke I, Gui Q, et al. Clinico-pathological investigations of rasmussen encephalitis suggest multifocal disease progression and associated focal cortical dysplasia. Epileptic Disord, 2013, 15(1): 32-43.
38. Garbelli R, Milesi G, Medici V, et al. Blurring in patients with temporal lobe epilepsy: clinical, high-field imaging and ultrastructural study. Brain, 2012, 135(Pt 8): 2337-2349.

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海马硬化相关的颞叶癫痫的短期和长期手术预后：与神经病理学的关系

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