Participants’ presurgical diagnostics.

ObjectiveLateral temporal lobe epilepsy (LTLE) has been diagnosed in only a small number of patients; therefore, its surgical outcome is not as well-known as that of mesial temporal lobe epilepsy. We aimed to evaluate the long-term (5 years) and short-term (2 years) surgical outcomes and identify possible prognostic factors in patients with LTLE.MethodsThis retrospective cohort study was conducted between January 1995 and December 2018 among patients who underwent resective surgery in a university-affiliated hospital. Patients were classified as LTLE if ictal onset zone was in lateral temporal area. Surgical outcomes were evaluated at 2 and 5 years. We subdivided based on outcomes and compared clinical and neuroimaging data including cortical thickness between two groups.ResultsSixty-four patients were included in the study. The mean follow-up duration after the surgery was 8.4 years. Five years after surgery, 45 of the 63 (71.4%) patients achieved seizure freedom. Clinically and statistically significant prognostic factors for postsurgical outcomes were the duration of epilepsy before surgery and focal cortical dysplasia on postoperative histopathology at the 5-year follow-up. Optimal cut-off point for epilepsy duration was eight years after the seizure onset (odds ratio 4.375, p-value = 0.0214). Furthermore, we propose a model for predicting seizure outcomes 5 years after surgery using the receiver operating characteristic curve and nomogram (area under the curve = 0.733; 95% confidence interval, 0.588–0.879). Cortical thinning was observed in ipsilateral cingulate gyrus and contralateral parietal lobe in poor surgical group compared to good surgical group (p-value ConclusionsThe identified predictors of unfavorable surgical outcomes may help in selecting optimal candidates and identifying the optimal timing for surgery among patients with LTLE. Additionally, cortical thinning was more extensive in the poor surgical group.Objective 外侧颞叶癫痫（Lateral temporal lobe epilepsy, LTLE）的确诊患者数量较少，因此其手术预后效果不如内侧颞叶癫痫（mesial temporal lobe epilepsy）为人熟知。本研究旨在评估外侧颞叶癫痫患者接受手术后的短期（2年）与长期（5年）预后，并明确潜在的预后影响因素。 Methods 本回顾性队列研究于1995年1月至2018年12月期间，在某大学附属医院开展，纳入接受切除术治疗的患者。若患者的癫痫发作起始区位于外侧颞叶区域，则将其归类为LTLE患者。分别在术后2年与5年对手术预后进行评估。本研究按手术预后结局进行分组，并对两组患者的临床资料与包括皮层厚度在内的神经影像学数据进行比较分析。 Results 本研究共纳入64例患者，术后平均随访时长为8.4年。术后5年时，63例患者中的45例（71.4%）实现无癫痫发作。术后5年随访结果显示，与手术预后相关的临床及统计学显著预后因素包括术前癫痫病程以及术后病理检测提示的局灶性皮层发育不良（focal cortical dysplasia）。术前癫痫病程的最优截断值为癫痫发作后8年（优势比为4.375，P值为0.0214）。此外，本研究借助受试者工作特征曲线（Receiver operating characteristic curve, ROC）与列线图（nomogram）构建了术后5年癫痫预后预测模型，其曲线下面积为0.733，95%置信区间为0.588~0.879。与预后良好组相比，预后不良组患者可见同侧扣带回与对侧顶叶皮层变薄（P值 Conclusions 本研究明确的不良手术预后预测因素，可为外侧颞叶癫痫患者的最优手术候选者筛选以及最佳手术时机选择提供参考。此外，预后不良组患者的皮层变薄范围更广。