Practice parameter: Temporal lobe and localized neocortical resections for epilepsy - Report of the quality standards subcommittee of the American Academy of Neurology, in association with the American Epilepsy Society and the American Association of Neurological Surgeons
Practice parameter: Temporal lobe and localized neocortical resections for epilepsy - Report of the quality standards subcommittee of the American Academy of Neurology, in association with the American Epilepsy Society and the American Association of Neurological Surgeons
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DOI：
10.1212/01.wnl.0000055086.35806.2d
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发表时间：
2003-02-25
期刊：
影响因子：
9.9
通讯作者：
Enos, B
中科院分区：
文献类型：
--
作者：
Engel, J;Wiebe, S;Enos, B
目的/方法：通过对1990年以来的文献进行系统回顾和分析，检查内侧前颞叶和局部新皮质切除术治疗致残性复杂部分性癫痫发作的有效性证据。结果如下：一项关于内侧颞叶癫痫手术治疗的I类意向治疗随机对照试验发现，随机接受手术治疗的患者中有58%（接受手术治疗的患者中有64%）没有致残性癫痫发作，10 - 15%在1年结束时没有改善，而随机接受继续药物治疗的患者中有8%没有致残性癫痫发作。手术组患者的定量生活质量评分有显著改善，1年结束时社会功能有改善的趋势，无手术死亡率，发病率低。24个IV类系列的颞叶切除术产生了基本相同的结果。局部新皮质切除术有类似的IV类结果;无I类或11类研究可用。结论：一项I类研究和24项IV类研究表明，前内侧颞叶切除术治疗致残性复杂部分性癫痫发作的获益大于持续抗癫痫药物治疗，风险至少相当。对于因癫痫发作而受损的患者，应强烈考虑转诊至癫痫手术中心。需要进一步的研究来确定新皮质癫痫发作是否受益于手术，以及早期手术干预是否应该是某些手术可治愈的癫痫综合征的治疗选择。
Objectives/Methods: To examine evidence for effectiveness of anteromesial temporal lobe and localized neocortical resections for disabling complex partial seizures by systematic review and analysis of the literature since 1990. Results: One intention-to-treat Class I randomized, controlled trial of surgery for mesial temporal lobe epilepsy found that 58% of patients randomized to be evaluated for surgical therapy (64% of those who received surgery) were free of disabling seizures and 10 to 15% were unimproved at the end of 1 year, compared with 8% free of disabling seizures in the group randomized to continued medical therapy. There was a significant improvement in quantitative quality-of-life scores and a trend toward better social function at the end of I year for patients in the surgical group, no surgical mortality, and infrequent morbidity. Twenty-four Class IV series of temporal lobe resections yielded essentially identical results. There are similar Class IV results for localized neocortical resections; no Class I or 11 studies are available. Conclusions: A single Class I study and 24 Class IV studies indicate that the benefits of anteromesial temporal lobe resection for disabling complex partial seizures is greater than continued treatment with antiepileptic drugs, and the risks are at least comparable. For patients who are compromised by such seizures, referral to an epilepsy surgery center should be strongly considered. Further studies are needed to determine if neocortical seizures benefit from surgery, and whether early surgical intervention should be the treatment of choice for certain surgically remediable epileptic syndromes.