Corpus callosotomy: A palliative therapeutic technique may help identify resectable epileptogenic foci
Corpus callosotomy: A palliative therapeutic technique may help identify resectable epileptogenic foci
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DOI：
10.1016/j.seizure.2007.04.004
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发表时间：
2007-09-01
影响因子：
3
通讯作者：
Baumgartner, James E.
中科院分区：
文献类型：
--
作者：
Clarke, Dave F.;Wheless, James W.;Baumgartner, James E.
作顽固性癫痫的姑息性治疗已有悠久的历史。识别单个表观形成区是成功进行切除手术的关键。我们描述了三个病例，在这些病例中，穹隆体切开术能够识别出不明显的癫痫灶，导致随后的成功切除。我们回顾了2003-2005年间我们的癫痫手术数据库，这些病例都是曾经进行过穹窿切开术的儿童，并且是局灶性切除的候选对象。所有儿童均接受了磁共振成像和头皮视频脑电图仪监测，其中两人进行了脑磁图、皮质脑电图仪和/或颅内视频脑电图仪监测。儿童年龄分别为8岁和9岁，发作开始时间从婴幼儿到儿童早期不等。其中1例在癫痫发作前有头部外伤史，1例有大面积脑梗塞和对侧额叶皮质发育不良，1例接受了前颞叶切除术，发作频率没有改善。在药物治疗失败后，进行了膝盖骨切开术，以期减少影响双侧大脑半球的发作类型。在医学难治性癫痫中，怀疑有快速的继发性双同步性发作，但脑电图仪是非局部性的，应考虑将其作为治疗全面性发作类型的一种手段，但也可能有助于确定潜在的可手术的发作灶。研究的局限性包括其回溯性和队列大小。然而，这些发现表明，在这一顽固的患者群体中，有必要进行前瞻性、系统性和良好对照的研究。(C)2007年英国癫痫协会。爱思唯尔有限公司出版。保留所有权利。
Corpus callosotomy has a tong history as a palliative treatment for intractable epilepsy. Identification of a single epiteptogenic zone is critical to performing successful resective surgery. We describe three patients in which corpus callosotomy allowed recognition of unapparent seizure foci, leading to subsequent successful resection.We retrospectively reviewed our epilepsy surgery database from 2003 to 2005 for children who had a prior callosotomy and were candidates for focal resection. All underwent magnetic resonance imaging and scalp video electroencephalograph monitoring, and two had magnetoencephalography, electrocorticography and/or intracranial video electroencephalograph monitoring.The children were 8 and 9 years old, and seizure onset varied from early infancy to early childhood. One child had a history of head trauma preceding seizure onset, one had a large intracerebral infarct and dysplastic cortex in the contralateral frontal lobe, and the other had an anterior temporal lobe resection without improvement in seizure frequency.After medical management failed, callosotomy was performed with the expectation of decreasing the seizure types affecting both hemispheres. Following transection of the callosal fibers, a single focus was recognized and resected, with resultant dramatic improvement in seizure control.In medically refractory epilepsy, where rapid secondary bisynchrony is suspected but the electroencephalograph is non-localizing, callosotomy should be considered as a means of treating generalized seizure types, but may also assist in identifying potentially operable seizure foci. Study limitations include its retrospective nature and cohort size. The findings, however, suggest the need for prospective, systematic, well-controlled studies of the use of corpus callostomy in this intractable patient population. (c) 2007 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.