| Objective: To analyze clinical features of drug-refractory temporal lobe epilepsy aura by applying stereo-electroencephalography(SEEG),and to explore the localization value of temporal lobe epilepsy aura on the preoperative evaluation and its prognostic value on the surgical outcome.Methods: The data profile of patients with drug-refractory temporal lobe epilepsy,who underwent stage I and II preoperative evaluation with deep brain electrodes for stereotactic EEG monitoring and anterior temporal lobectomy at the First Affiliated Hospital of the University of Science and Technology of China(Comprehensive Epilepsy Center)from January 2018 to April 2021,was retrospectively analyzed.The patient’s clinical data were summarized,the multimodal neuroimaging post-processing results,SEEG interictal and ictal EEG data,and neuropsychological manifestations were comprehensively evaluated,and the trinity of "anatomy-electrophysiology-clinical symptoms" was followed to locate the origin and conduction of intracranial electrical signals,and deep brain electrodes were used to The patient will be electrically stimulated with deep brain electrodes to localize the functional areas of the brain.The patients were followed up regularly for at least 12 months.The correlation between the patient’s aura,pathological findings,surgical side,epileptogenic area and prognosis of the surgery was analyzed statistically.The patients were divided into aura-positive and aura-negative groups according to the presence of aura in seizures,and the differences in clinical characteristics,seizure frequency before and after surgery,and surgical outcome between the two groups were compared.We also summarized the type and number of aura and compared them with surgical outcomes,exploring the prognostic value of aura on the surgical outcome.Results: 1.A total of 40 patients with epilepsy who met the study criteria were included in this study.313 electrodes were implanted in all patients,with a mean of 7.83 ± 2.38 electrodes implanted,and the postoperative follow-up was 12-52 months,with a mean follow-up of 29.68 ± 14.81 months.27(67.5%)patients were seizure-free until the last follow-up.There were 27 patients in the aura-positive group with a disease duration of13.59 ± 5.13 years.There were 13 patients in the aura-negative group with a disease duration of 17.92 ± 4.03 years.There were no statistical differences in gender,age,surgical side,pathological findings,and cranial MRI manifestations(presence of hippocampal sclerosis)between the two groups.2.The incidence of aura in temporal lobe epilepsy was 67.5%,with 42.5% of patients having only a single aura and 10 patients(25.0%)having multiple auras in the aura-positive group.The most common temporal lobe epilepsy aura was the abdominal aura [13(34.2%)patients],followed by sensory(23.6%),affective and experiential(21.1%),and autonomic(21.1%)auras.After multifactorial logistic regression analysis,the only variable associated with seizure outcome in this study was the presence of aura(P = 0.011).3.Seizure control after surgery was significant in both the aura-positive and aura-negative groups.There was a statistically significant decrease in postoperative seizure frequency compared to preoperative seizure frequency when comparing within group in both groups,and a more significant decrease in postoperative seizure frequency in the aura-positive group compared to the aura-negative group when comparing between the two groups.Among patients who experienced more than 15 years of seizure duration,those with persistent aura had a better prognosis(P = 0.040).4.In the preoperative evaluation,aura-positive patients had a better surgical outcome if the laterality of positron emission tomography-computed tomography(PET-CT)hypometabolism was concordant with the epileptogenic focus identified with SEEG(P = 0.031).A good postoperative epileptic outcome in aura-positive patients was observed among those with hippocampal sclerotic medial temporal lobe epilepsy(P= 0.025).5.Comparison of the type and number of auras with surgical prognosis(results corrected for multiple comparisons): patients with abdominal aura(P = 0.029)and single aura(P = 0.036)had a better surgical prognosis than patients with negative aura.Conclusion:1.Epileptic aura is valuable for the localization of the epileptogenic focus.2.The presence of aura symptoms is a protective factor for surgical outcome in patients with refractory temporal lobe epilepsy.Abdominal aura and single aura are good predictors of outcome in anterior temporal lobectomy.3.Patients with aura symptoms are more likely to benefit from surgery in patients with hippocampal sclerosis on multimodal neuroimaging assessment.4.Among patients with a preoperative diagnosis of hippocampal sclerosis or with laterality of PET-CT hypometabolism concordant with the epileptogenic focus identified using SEEG,those with aura are likely to benefit from surgery. |
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