Surgical treatment for refractory epilepsy: review of patient evaluation and surgical options.
Surgical treatment for refractory epilepsy: review of patient evaluation and surgical options.
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DOI：
10.1155/2011/303624
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发表时间：
2011
期刊：
影响因子：
--
通讯作者：
Chung SS
中科院分区：
文献类型：
--
作者：
Kelly KM;Chung SS
癫痫的治疗通常需要使用各种抗癫痫药物，并且需要患者的长期承诺和依从性。虽然现在有许多新的药物可用于治疗癫痫，但大约30%的癫痫患者仍然会出现反复发作，许多人还会出现不良副作用。癫痫的治疗需要多学科的方法。对于那些医学上难治性癫痫发作的患者，随着技术和设备的改进，手术治疗的流行率增加了。随着使用率的提高，正确的患者选择已成为评估手术干预是否适当的关键。手术已被证明有效的癫痫综合征包括内侧颞叶硬化、皮质发育不良、许多小儿癫痫综合征和血管畸形。连续头皮或颅内脑电图监测是癫痫发作病灶定位的重要步骤。核磁共振成像是评估解剖学的标准成像技术。然而，包括SPECT和PET在内的其他影像学研究已经变得越来越普遍，通常在某些情况下提供更高的诊断价值。此外，作为手术切除的替代或辅助手段，植入式装置如迷走神经刺激器、深部脑刺激器和直接脑刺激器可用于癫痫发作的治疗。
Treatment of epilepsy often imposes an exposure to various antiepileptic drugs and requires long-term commitment and compliance from the patient. Although many new medications are now available for the treatment of epilepsy, approximately 30% of epilepsy patients still experience recurrent seizures and many experience undesirable side effects. Treatment of epilepsy requires a multidisciplinary approach. For those patients with medically refractory seizures, surgical treatment has increased in prevalence as techniques and devices improve. With increased utilization, proper patient selection has become crucial in evaluating appropriateness of surgical intervention. Epilepsy syndromes in which surgery has shown to be effective include mesial temporal sclerosis, cortical dysplasia, many pediatric epilepsy syndromes, and vascular malformations. Monitoring in an epilepsy monitoring unit with continuous scalp or intracranial EEG is an important step in localization of seizure focus. MRI is the standard imaging technique for evaluation of anatomy. However, other imaging studies including SPECT and PET have become more widespread, often offering increased diagnostic value in select situations. In addition, as an alternative or adjunct to surgical resection, implantable devices such as vagus nerve stimulators, deep brain stimulators, and direct brain stimulators could be useful in seizure treatment.