Analysis of factors influencing surgical outcomes in frontal lobe epilepsy

doi:10.19854/j.cnki.1008-2425.2026.03.0008

Abstract

Abstract: Objective To investigate the factors influencing surgical outcomes in patients with frontal lobe epilepsy. Methods Clinical data of 32 patients with frontal lobe epilepsy who underwent surgical treatment at the Epilepsy Center of our hospital from January 2019 to June 2024 were retrospectively collected.The postoperative follow-up period ranged from 12 to 36 months.Patients were categorized into a favorable outcome group (Engel Class I) and an unfavorable outcome group (Engel Classes II–IV) based on the Engel classification.Univariate analysis and multivariate binary logistic regression were performed to identify independent factors affecting surgical outcomes. Results The follow-up rate was 100%.Nineteen patients (59.4%) achieved favorable outcomes,while 13 (40.6%) had unfavorable outcomes.Univariate analysis revealed that disease duration,preoperative MRI findings,intraoperative definitive localization of the epileptogenic zone,and complete resection were associated with favorable outcomes (all P＜0.05).Multivariate logistic regression showed that negative preoperative MRI findings (OR=0.057,95%CI:0.004–0.817,P=0.035) and disease duration≥10 years(OR=0.038,95%CI:0.004–0.368,P=0.005) were independent risk factors for unfavorable postoperative outcomes. Conclusion Disease duration ≥10 years and negative preoperative MRI suggest a poorer prognosis after frontal lobe epilepsy surgery.Early surgical intervention should be considered for suitable patients,and definitive identification of MRI-positive epileptogenic foci before surgery is of great significance for improving prognosis.

Key words: Frontal lobe epilepsy, Surgical treatment, Prognosis, Influencing factors, Stereoelectroencephalography (SEEG)

摘要： 目的探讨影响额叶癫痫手术疗效的相关因素。方法回顾性收集2019年1月至2024年6月在本院癫痫中心接受手术治疗的32例额叶癫痫患者的临床资料。术后随访12～36个月,依据Engel分级分为预后良好组(EngelⅠ级)与预后不佳组(EngelⅡ～Ⅳ级)。采用单因素及多因素Logistic回归分析筛选影响手术疗效的独立因素。结果随访率100%,预后良好19例(59.4%),预后不佳13例(40.6%)。单因素分析显示,病程、术前MRI结果、术中致痫灶定位明确及完全切除与良好预后相关(P＜0.05)。多因素分析显示,术前MRI阴性(OR=0.057,95%CI:0.004～0.817,P=0.035)及病程≥10年(OR=0.038,95%CI:0.004～0.368,P=0.005)是术后预后不佳的独立危险因素。结论病程≥10年及术前MRI阴性提示额叶癫痫术后预后较差,应尽早对适宜患者实施手术,术前明确MRI致痫灶对改善预后具有重要意义。

关键词: 额叶癫痫, 手术治疗, 预后, 影响因素, 立体定向脑电图

CLC Number:

R742.1

Ou Chun, Lu Jun, Wang Zhongming, Chen Pan, Jiang Hui, Jiang Bing. Analysis of factors influencing surgical outcomes in frontal lobe epilepsy[J]. Chinese Journal of Stereotactic and Functional Neurosurgery, 2026, 39(3): 181-185.

欧春, 卢军, 王中鸣, 陈攀, 姜卉, 姜兵. 额叶癫痫手术疗效的影响因素分析[J]. 立体定向和功能性神经外科杂志, 2026, 39(3): 181-185.

References

[1] 何文斌,赵明睿,沈云娟,等.额叶癫痫患者手术后疗效及其影响因素的分析研究[J].癫痫杂志,2021,7(3):234-240.
[2] 张筱瑜,张龑冏,卢晓栋,等.儿童额叶癫痫的临床特征以及切除性手术预后研究——儿童癫痫中心的经验[J].癫痫杂志,2022,8(4):297-303.
[3] Lamberink HJ,Otte WM,Blümcke I,et al.Seizure outcome and use of antiepileptic drugs after epilepsy surgery according to histopathological diagnosis:a retrospective multicentre cohort study[J].Lancet Neurol,2020,19(9):748-757.doi:10.1016/S1474-4422(20)30220-30229.
[4] Meng Q,Li H,Liu Y,et al.Clinical characteristics and predictors of seizure recurrence in children and adults undergoing frontal lobe epilepsy surgery:a comparative study[J].J Clin Neurosci,2025,136:111227.
[5] Riaño-Carreño DM,Cardenas AF,Ramirez-Triana J,et al.Predictors of surgical outcome in frontal lobe epilepsy:experience from a single-center cohort in Latin America[J].Epilepsy Res,2026,219:107693.
[6] Gholipour T,Koubeissi MZ,Shields DC.Stereotactic electroencephalography[J].Clin Neurol Neurosurg,2020,189:105640.
[7] 张弨,胡文瀚,王秀,等.额叶癫痫简单运动症状和复杂运动症状临床特点及癫痫传播网络的研究[J].临床神经外科杂志,2020,17(2):145-149.
[8] Maesawa S,Ishizaki T,Mutoh M,et al.Clinical impacts of stereotactic electroencephalography on epilepsy surgery and associated issues in the current situation in Japan[J].Neurol Med Chir(Tokyo),2023,63(5):197-205.
[9] Muthiah N,Reecher H,Maroufi S,et al.Seizure outcomes and complications associated with stereoelectroencephalography versus subdural electrodes for invasive monitoring in epilepsy surgery:a meta-analysis[J].Front Neurol,2026,16:1619288.doi:10.3389/fneur.2025.1619288.
[10] Samuel P J,Menon RN,Chandran A,et al.Seizure outcome and its predictors after frontal lobe epilepsy surgery[J].Acta Neurol Scand,2019,140(4):259-267.
[11] Xu C,Yu T,Zhang G,et al.Prognostic factors and longitudinal change in long-term outcome of frontal lobe epilepsy surgery[J].World Neurosurg,2019,121:e581-e591.
[12] 邵道广.药物难治性额叶癫痫的手术效果及预后因素[D].厦门大学,2021.
[13] Santos-Santos A,Morales-Chacón LM,Galan-Garcia L,et al.Short and long term prediction of seizure freedom in drug-resistant focal epilepsy surgery[J].Clin Neurol Neurosurg,2023,230:107753.
[14] Weil AG,Dimentberg E,Lewis E,et al.Development of an online calculator for the prediction of seizure freedom following pediatric hemispherectomy using the Hemispherectomy Outcome Prediction Scale (HOPS)[J].Epilepsia,2024,65(1):146-156.
[15] 王玲,柳江燕,任婉娜.PET-CT和PET-MRI在药物难治性癫痫中的研究进展[J].癫痫杂志,2021,7(3):257-261.
[16] 张昭昭,周君剑,刘垚岭,等.立体定向颅内脑电图在难治性癫痫治疗中的价值(附30例临床分析)[J].立体定向和功能性神经外科杂志,2021,34(1):1-3.
[17] Tsai MC,Starnes K,Fine AL,et al.Long-term seizure outcome in pediatric and adolescent patients receiving curative and palliative frontal lobe epilepsy surgery[J].Epilepsy Behav,2025,172:110710.
[18] 姜卉,姜兵,张伟,等.局灶性皮层发育不良相关难治性癫痫的手术预后影响因素分析[J].中国现代手术学杂志,2023,27(2):139-144.
[19] Millán AP,van Straaten ECW,Stam CJ,et al.Epidemic models characterize seizure propagation and the effects of epilepsy surgery in individualized brain networks based on MEG and invasive EEG recordings[J].Sci Rep,2022,12(1):4086.
[20] Rijal S,Corona L,Perry MS,et al.Functional connectivity discriminates epileptogenic states and predicts surgical outcome in children with drug resistant epilepsy[J].Sci Rep,2023,13(1):9622.
[21] Yang C,Liu Z,Luan G,et al.The extension of epileptogenicity as the driving force of the epileptogenic network evolution and complex symptoms[J].Brain Res,2020,1748:147073.
[22] Obaid S,Guberman GI,St-Onge E,et al.Progressive remodeling of structural networks following surgery for operculo-insular epilepsy[J].Front Neurol,2024,15:1400601.
[23] Guo J,Wang Z,van‘t Klooster MA,et al.Seizure outcome after intraoperative electrocorticography-tailored epilepsy surgery:a systematic review and meta-analysis[J].Neurology,2024,102(11):e209430.