RESUMO
Contexte et objectifs Environ 30% des patients epileptiques ne repondent pas au traitement medical et deviennent des candidats potentiels pour un traitement chirurgical dont l'indication repose sur les donnees electro-cliniques et d'imagerie. L'objectif de cette etude etait de decrire les caracteristiques anthropometriques et cliniques ainsi que l'evolution sous traitement des patients epileptiques; de documenter le niveau d'investigation de cette pathologie afin d'identifier les patients potentiellement eligibles pour un traitement chirurgical. Methodologie Il s'agit d'une etude documentaire descriptive couvrant une periode de 2 ans. Les variables d'interet comprenaient : les donnees anthropometriques; les caracteristiques de l'epilepsie; les donnees therapeutiques; le niveau et les resultats des investigations complementaires. Resultats Au total; 1184 dossiers de nouveaux cas d'epilepsie ont ete retenus. L'age median etait de 19 ans avec un sex ratio H/F de 1;1. 68% des patients avaient un age de debut inferieur a 20 ans et plus de 90% avaient des crises generalisees tonico-cloniques. La disparition des crises sous traitement etait observee chez 31% des patients et 22% avaient une persistance ou une aggravation. L'EEG etait realise chez 17% des patients et le scanner cerebral chez 0;8%. Vingt (20 )% des patients avaient recu au moins 2 antiepileptiques. Environ 26 % des patients suivis pendant 2 ans ou plus etaient consideres refractaires. Conclusion L'epilepsie affecte les patients en age scolaire et les jeunes adultes qui sont des candidats de choix pour la chirurgie en cas de pharmaco-resistance. La pathologie reste cependant tres peu investiguee. Un programme d'investigation plus large permettra d'identifier notamment les epilepsies lesionnelles afin de soumettre ces patients a une evaluation en vue d'un traitement neurochirurgical
RESUMO
BACKGROUND: : Multiple subpial transection (MST) is a potential surgical treatment for patients with epileptogenic foci located in cortical areas with higher functions. As neurosurgical teams have become more experienced with MST, the original technique has adapted. OBJECTIVE: : To report our 6-year experience with a modified MST technique. METHODS: : The population included 62 consecutive patients with medically refractory epilepsy treated by MST, with a follow-up period ranging from 2 to 9 years. MST was performed on gyri under neuronavigation and guided by intraoperative electrocorticography. We performed radiating MST from a single cortical entry point. The MST technique was described according to the number of transections performed and the Brodmann areas (BAs) involved. Any MST-related complications were registered and followed up. Clinical outcome was described in terms of seizure suppression or reduction according to the Engel modified classification. RESULTS: : Twelve patients underwent MST alone (MSTa), and 50 had MST with another procedure. The main MST sites were BA 4 (61%) and 3, 1, 2 (58%); in 22% of cases, MST was performed in BA 44, 22, 39, and 40. Permanent neurological deficits were observed in 4 (6.4%) patients; 2 minor deficits were MST related (3.2%). A reduction in the seizure rate of at least 50% was seen in 79% of patients (MSTa group, 75%), and 42% became seizure free (MSTa group, 33%). CONCLUSION: : This study demonstrates the efficacy and low morbidity of radiating MST performed under neuronavigation and intraoperative electrocorticography. ABBREVIATIONS: : BA, Brodmann areaEEG, electroencephalogramFDG, 18-fluorodeoxyglucoseioECoG, intraoperative electrocorticographyMRE, medically refractory epilepsyMST, multiple subpial transectionMSTa, multiple subpial transection aloneMST+, multiple subpial transection with other procedures.
