Seizure outcomes in nonresective epilepsy surgery: an update.
Seizure outcomes in nonresective epilepsy surgery: an update.
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DOI：
10.1007/s10143-016-0725-8
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发表时间：
2017-04
影响因子：
2.8
通讯作者：
Chang EF
中科院分区：
文献类型：
--
作者：
Englot DJ;Birk H;Chang EF
在大约30%的癫痫患者中，癫痫发作对药物治疗难治性，导致显著的发病率和死亡率增加。大量证据表明手术切除对耐药局灶性癫痫患者有益，在本期杂志中，我们最近回顾了切除性癫痫手术的癫痫发作结果。然而，并不是所有的患者都适合或适合开放手术切除癫痫。幸运的是，现在在各种癫痫中心有几种非切除手术选择，包括近年来首创的新疗法。立体定向激光消融和立体定向放射外科等消融手术为开放性手术提供了相对有利的癫痫发作结果的微创替代方案，特别是对于内侧颞叶癫痫患者。对于某些不适合消融或切除的患者，姑息性神经调节手术，如迷走神经刺激、深部脑刺激或反应性神经刺激，可显著降低癫痫发作频率，提高生活质量。最后，分离手术，如多次基底下横断和胼胝体切开术，分别在有明显癫痫区或难治性失张力发作的患者中继续发挥作用。总的来说，开放性手术切除仍然是治疗耐药癫痫的金标准，尽管它的使用率明显不足。虽然非切除性癫痫手术还没有取代切除的需要，但有希望这些额外的手术选择将增加接受这种毁灭性疾病治疗的患者数量，特别是那些不适合切除或切除失败的患者。
In approximately 30% of patients with epilepsy, seizures are refractory to medical therapy, leading to significant morbidity and increased mortality. Substantial evidence has demonstrated the benefit of surgical resection in patients with drug-resistant focal epilepsy, and in the present journal, we recently reviewed seizure outcomes in resective epilepsy surgery. However, not all patients are candidates for or amenable to open surgical resection for epilepsy. Fortunately, several non-resective surgical options are now available at various epilepsy centers, including novel therapies which have been pioneered in recent years. Ablative procedures such as stereotactic laser ablation and stereotactic radiosurgery offer minimally invasive alternatives to open surgery with relatively favorable seizure outcomes, particularly in patients with mesial temporal lobe epilepsy. For certain individuals who are not candidates for ablation or resection, palliative neuromodulation procedures such as vagus nerve stimulation, deep brain stimulation, or responsive neurostimulation may result in a significant decrease in seizure frequency and improved quality of life. Finally, disconnection procedures such as multiple subpial transections and corpus callosotomy continue to play a role in select patients with an eloquent epileptogenic zone or intractable atonic seizures, respectively. Overall, open surgical resection remains the gold standard treatment for drug-resistant epilepsy, although it is significantly under-utilized. While non-resective epilepsy procedures have not replaced the need for resection, there is hope that these additional surgical options will increase the number of patients who receive treatment for this devastating disorder - particularly individuals who are not candidates for or who have failed resection.