When drugs and surgery don't work
When drugs and surgery don't work
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DOI：
10.1111/j.1528-1167.2008.01930.x
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发表时间：
2008-01-01
期刊：
影响因子：
5.6
通讯作者：
Cascino, Gregory D.
中科院分区：
文献类型：
--
作者：
Cascino, Gregory D.
癫痫是一种慢性疾病，其特征为反复发作和无端发作（Dreifuss，1987;豪瑟和Hesdorffer，1990）。它是成人最常见的神经系统疾病之一。发生癫痫的终生风险为3.2%（Mattson，1992）。大约90%的成人发病病例有症状的部分或局部相关癫痫（Camfield & Camfield，1996;豪瑟& Hesdorffer，1990;豪瑟，1992）。内侧颞叶是大脑中最易致癫痫的区域（吕比等人，1995; Jeong等人，1999年; Wiebe等人，2001年）。致痫区下面的病理损伤包括内侧颞叶硬化（MTS）、肿瘤、血管异常、皮质发育畸形（MCD）和头部创伤（Cascino等人，1993; Radhakrishnan等人，1998年）。对药物的初始反应具有重要的预后意义（豪瑟，1992）。有远隔症状的神经系统疾病、外来组织损伤、发育迟缓或神经系统检查异常的患者不太可能无神经系统疾病。治疗的目标是使个体免于癫痫，而不产生抗癫痫药物（AED）毒性，使个体成为社会的参与和生产成员（Engel & Ojemann，1993）。尽管引入了“较新”的AED，但近一半的部分性癫痫患者在药物治疗下无法达到癫痫发作缓解（Kwan & Brodie，2003）。本讨论的重点是治疗难治性部分性癫痫发作的成年患者，这些疾病是医学难治性的，可能无法手术治疗。据估计，美国200万部分性癫痫患者中有40万人患有医学难治性部分性癫痫发作障碍（豪瑟& Hesdorffer，1990;豪瑟，1992）。据估计，美国每年有1,500名患者接受癫痫手术。英国的一项研究表明，每年有30，000名患者发生癫痫，约6，000名患者患有医学难治性癫痫发作（Lhatoo等人，2003年）。然而，英国每年只有大约400例癫痫手术。因此，难治性部分性癫痫患者的数量是医学难治性的，可能不是手术可治愈的癫痫综合征是显着的。
Epilepsy is a chronic disorder characterized by recurrent and unprovoked seizures ( Dreifuss, 1987; Hauser & Hesdorffer, 1990). It is one of the most common neurologic disorders in the adult. The lifetime risk of developing epilepsy is 3.2% (Mattson, 1992). Approximately 90% of the incident cases in adults have symptomatic partial or localization-related epilepsy (Camfield & Camfield, 1996; Hauser & Hesdorffer, 1990; Hauser, 1992). The medial temporal lobe is the most epileptogenic region of the brain (Luby et al., 1995; Jeong et al., 1999; Wiebe et al., 2001). Pathologic lesions underlying the epileptogenic zone include mesial temporal sclerosis (MTS), tumor, vascular anomaly, malformations of cortical development (MCDs), and head trauma (Cascino et al., 1993; Radhakrishnan et al., 1998). The initial response to medication is of prognostic importance ( Hauser, 1992). Patients with a remote symptomatic neurologic disease, foreign-tissue lesion, developmental delay, or abnormal neurologic examination are less likely to be rendered seizure-free. The goals of treatment are to render the individual seizure-free without producing antiepileptic drug (AED) toxicity, allowing the individual to become a participating and productive member of society (Engel & Ojemann, 1993). Despite the introduction of "newer'' AEDs, nearly one-half of patients with partial epilepsy will not attain a seizure remission with pharmacotherapy (Kwan & Brodie, 2003). This discussion focuses on management of the adult patient with intractable partial seizure disorders that are medically refractory and may not be surgically remediable. It is estimated that 400,000 of the 2 million individuals with partial epilepsy in the United States have a medically refractory partial seizure disorder ( Hauser & Hesdorffer, 1990; Hauser, 1992). An estimated 1,500 patients in the United States undergo epilepsy surgery each year. A UK study indicated that 30,000 patients develop epilepsy each year and approximately 6,000 have medically refractory seizures (Lhatoo et al., 2003). However, there are only about 400 epilepsy surgeries performed annually in the UK. Therefore, the number of patients with intractable partial epilepsy that is both medically refractory and possibly not a surgically remediable epileptic syndrome is significant.