[Surgically treatable epilepsy--a review].
[Surgically treatable epilepsy--a review].
复制标题
[可手术治疗的癫痫——综述]。
作者：
J. Janszky;G. Rásonyi;A. Fogarasi;L. Bognár;L. Erőss;P. Barsi;P. Halász
20 - 25%的癫痫患者在接受适当的药物治疗后仍无法摆脱癫痫发作。在25 - 50%的难治性癫痫患者中，引发癫痫发作的脑区能够很好地定位，且不涉及语言等重要功能区。对于这些患者，手术切除癫痫病灶可能会缓解癫痫发作。在匈牙利，可能有5000 - 6000名患者需要进行癫痫手术，但到目前为止，只有200名慢性癫痫患者接受了手术治疗。在可通过手术治疗的癫痫中，手术并非“最后手段”。对于这些综合征，如果在癫痫发作后的1 - 3年内，2 - 3种适当的抗癫痫药物未能使患者摆脱癫痫发作，那么就有必要进行术前评估。最常见的可手术治疗的癫痫是颞叶癫痫，其中60 - 90%的耐药患者可通过手术治愈。在病灶性新皮质癫痫中，50 - 80%的患者术后不再发作。在儿童半球性癫痫中，手术可使70 - 80%的患者摆脱癫痫发作。术前评估的基本工具包括详细的病史、高分辨率磁共振成像（MRI）、视频脑电图（EEG）监测以及神经心理学评估。这些检查方法通常足以评估手术的必要性、术后结果以及规划切除的部位和范围。在某些情况下，发作期单光子发射计算机断层成像（SPECT）、正电子发射断层成像（PET）或使用颅内电极进行视频脑电图监测可能也是必要的，以便定位癫痫病灶。
20-25% of epileptic patients do not become seizure free on adequate drug therapy. In 25-50% of patients with intractable epilepsy, the brain area responsible for seizures is well localizable and does not involve eloquent regions. In these patients, the surgical excision of the epileptic focus may lead to relief from seizures. In Hungary, there may be 5-6000 patients who needs an epilepsy surgery, but till now only 200 patients with chronic epilepsy underwent a surgical procedure. In the surgically remediable epilepsies, the operation is not a "ultima ratio". Concerning these syndromes, if 2-3 adequate antiepileptic drugs do not lead to seizure freedom within 1-3 years after the epilepsy onset, then a presurgical evaluation is necessary. The most common surgically remediable epilepsy is the temporal lobe epilepsy in which 60-90% of drug-resistant patients could be surgically cured. In lesional neocortical epilepsies 50-80% of patients become postoperatively seizure free. In childhood hemispheric epilepsies, the surgery could lead to seizure freedom in 70-80% of patients. The basic tools of the presurgical evaluation are the detailed history, the high resolution-MRI, the video-EEG monitoring, and the neuropsychological assessment. These investigation methods are usually enough to evaluate the necessity of the surgery and the postoperative outcome as well as to plan the localization and the extension of the resection. In some cases, ictal SPECT, PET, or video-EEG monitoring with intracranial electrodes could also be necessary in order to localize the epileptic focus.