The Concept of Drug-Resistant Epileptogenic Zone
The Concept of Drug-Resistant Epileptogenic Zone
复制标题
耐药致痫区的概念。
DOI：
10.3389/fneur.2019.00558
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发表时间：
2019-05-31
影响因子：
3.4
通讯作者：
Kwan, Patrick
中科院分区：
文献类型：
--
作者：
Zhang, Chunbo;Kwan, Patrick
切除手术是治疗耐药性癫痫最有效的方法。尽管进行了广泛的术前评估，但只有 30-70% 的患者在手术后不会出现癫痫发作。需要新的方法和策略来改善癫痫手术的结果。临床实践中经常观察到，对于术前未控制的大部分患者，抗癫痫药物（AED）可以在术后维持无癫痫发作。在一些患者中，停止使用 AED 会导致癫痫复发，在大多数情况下，可以通过恢复 AED 来控制癫痫发作。这些观察结果表明，手术已将癫痫从耐药性转变为药物反应性，这意味着手术去除了导致耐药性的脑组织，而不是癫痫的病理基质（至少不是完全）。基于这些观察，假设存在一个与致癫痫区（EZ）重叠的耐药致癫痫区（DREZ），并且具有致癫痫和耐药特性。 DREZ 对于引起耐药性癫痫是必要且充分的，去除它会使癫痫出现药物反应性。检验这一假设需要开发新方法来定义 DREZ，当致痫区无法完全切除时，该方法可用于指导手术计划。这个概念还可以帮助理解耐药性癫痫的机制，从而产生新的治疗策略。
Resective surgery is the most effective way to treat drug-resistant epilepsy. Despite extensive pre-surgical evaluation, only 30-70% patients would become seizure-free after surgery. New approaches and strategies are needed to improve the outcome of epilepsy surgery. It is commonly observed in clinical practice that antiepileptic drugs (AEDs) could maintain seizure freedom in a large proportion of patients after surgery, who were uncontrolled before the operation. In some patients cessation of AEDs leads to seizure recurrence which, in most cases, can be controlled by resuming AEDs. These observations suggest that the surgery has converted the epilepsy from drug-resistant to drug-responsive, implying that the operation has removed the brain tissue accounting for pharmacoresistance, rather than the pathological substrate of epilepsy (at least not completely). Based on these observations, it is hypothesized that there is a drug-resistant epileptogenic zone (DREZ) which overlaps with the epileptogenic zone (EZ), and has both epileptogenic and drug-resistant properties. DREZ is necessary and sufficient to cause drug-resistant epilepsy, and its remove would render the epilepsy drug-responsive. Testing the hypothesis requires the development of new methods to define the DREZ, which may be used to guide surgical planning when the epileptogenic zone cannot be completely excised. This concept can also help understand the mechanisms of drug-resistant epilepsy, leading to new therapeutic strategies.