Factores de Riesgo para Recurrencia de Convulsiones y Pronóstico a Corto Plazo en Cirugía de Epilepsia para Esclerosis Mesial Temporal.
Palabras clave:
Cirugía de epilepsia, convulsiones, epilepsia del lóbulo temporal, esclerosis mesial temporal, factores de riesgo, pronóstico, recurrencia, Epilepsy surgery, mesial temporal sclerosis, outcome, recurrence, risk factors, seizures, temporal lobe epilepsy.Resumen
Objetivo: Determinar los factores de riesgo para recurrencia de convulsiones y la clasificación posquirúrgica a corto plazo en pacientes operados por esclerosis mesial temporal (EMT).
Métodos: Estudio de casos y controles anidado en la cohorte de pacientes con EMT diagnosticados por resonancia magnética con dos años de seguimiento posquirúrgico; se excluyeron pacientes con EMT bilateral. Se evaluaron características clínicas prequirúrgicas, foco epileptogénico en video-EEG y variables quirúrgicas con respecto a recurrencia de convulsiones en los primeros dos años posquirúrgicos y clasificación de Engel en el primer y segundo aniversario de la cirugía.
Resultados: Entre octubre de 2001 y junio de 2008 se han evaluado 144 pacientes con EMT candidatos a cirugía de epilepsia; a junio de 2007, se han operado 89 pacientes, 51.7% con EMT izquierda. 35.8% de los pacientes presentaron recurrencia de convulsiones antes del segundo año posquirúrgico; el factor de riesgo prequirúrgico asociado a recurrencia fue foco bitemporal o temporal único con diseminación contralateral por video-EEG (OR: 6.32; IC95% 1.64-26.41), y posquirúrgico, la presencia de convulsiones durante el primer mes posoperatorio (p:0.0004); no se encontró asociación con recurrencia para: género, convulsiones tónico-clónicas generalizadas prequirúrgicas, lado de la EMT ni tiempo de evolución prequirúrgica de la epilepsia. 66.3% y 75.8% de los pacientes estaban en Engel I al primer y segundo aniversario de la cirugía, respectivamente. 91% de los pacientes intervenidos estaban en buen pronóstico posquirúrgico a los dos años.
Conclusión: La localización del foco epileptogénico por electrofisiología es factor determinante en el pronóstico posquirúrgico a corto plazo en EMT.
Palabras clave
Cirugía de epilepsia, convulsiones, epilepsia del lóbulo temporal, esclerosis mesial temporal, factores de riesgo, pronóstico, recurrencia.
SummaryAim: To establish risk factors for seizure recurrence and short term Engel classification after surgery for Mesial Temporal Sclerosis (MTS).
Patients and methods: Nested case-control study in a cohort of patients diagnosed with MTS by magnetic resonance imaging and who had at least two years of postsurgical follow-up; patients with bilateral MTS were excluded. Clinical characteristics, epileptogenic focus in video- EEG and surgical issues were evaluated regarding to seizure recurrence during the first two postsurgical years and Engel classification in the first and second anniversary after surgery.
Results: From October 2001 to June 2008, 144 patients with MTS were evaluated as candidates for epilepsy surgery; until June 2007, 89 patients underwent epilepsy surgery, 51.7% with left MTS. 35.8% of patients experienced seizure recurrence before two post-surgical years; presurgical risk factor associated to this recurrence was bitemporal focus or single temporal focus with contralateral dissemination by video-EEG (OR: 6.32; CI95% 1.64-26.41), and post-surgical, seizures that occurred in the first month of surgery (p: 0004). No association with seizure recurrence was found with gender, presurgical tonic-clonic seizures, MTS side and epilepsy duration. 66.3% and 75.8% of patients were Engel I classified in the first and second anniversary after surgery, respectively. 91% of operated patients showed a good outcome after two years of epilepsy surgery.
Conclusion: Epileptogenic focus location by electrophysiology is a fundamental factor in short term outcome after surgery for MTS.
Key words
Epilepsy surgery, mesial temporal sclerosis, outcome, recurrence, risk factors, seizures, temporal lobe epilepsy.
Biografía del autor/a
Héctor Jaramillo Betancur, Instituto Neurológico de Antioquia. Medellín (Colombia).
Marta Jiménez Jaramillo, Instituto Neurológico de Antioquia. Medellín (Colombia).
Mónica Massaro Ceballos, Instituto Neurológico de Antioquia. Medellín (Colombia).
Maestría en Epidemiología. Universidad CES. Medellín (Colombia). -
Eduardo Cortés Silva, Instituto Neurológico de Antioquia. Medellín (Colombia).
Diana Marcela Restrepo Marín, Universidad CES. Medellín (Colombia).
Ofelia Mora López, Instituto Neurológico de Antioquia. Medellín (Colombia).
Iván Jiménez Ramírez, Instituto Neurológico de Antioquia. Medellín (Colombia).
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