Bartolomei F, Guye M, Gavaret M, Régis J, Wendling F, Raybaud C, Chauvel P
Service de Neurophysiologie Clinique-Unité d'Epileptologie, INSERM 9926-CHU Timone, Marseille, France.
Rev Neurol (Paris). 2002 May;158(5 Pt 2):4S55-64.
In this article, we present an overview of the principles, practices and procedures of the presurgical evaluation of the epilepsies in use in our center and in the majority of French teams. Surgery for epilepsy is offered to patients presenting with severe epilepsy with partial seizures. Its aim is to stop the seizures, or to significantly reduce their frequency. To do that, the epileptogenic zone should theoretically be removed and/or the propagation pathways of the seizures should be cut. Discussion of these indications inevitably includes prior assessment of the functional sequels (sensory, motor, cognitive or behavioral) which surgery is liable cause. The presurgical evaluation involves a multidisciplinary approach involving epileptologists, neurophysiologists, neuroradiologists, neuropsychologists and neurosurgeons and is carried out in two phases. The phase I is based on non-invasive investigations, including functional and structural neuroimaging, neuropsychological assessment, source localization of interictal spike and video-EEG recordings of seizures. The phase II is often required and is aimed to precisely define the anatomical localization of the epileptogenic zone and the relationships with a structural lesion. This invasive phase is mainly based on stereoelectroencephalography (SEEG). Finally, the surgical procedure must be adapted according to the distribution and dynamics of the anatomical and functional abnormalities which individually define each case of epilepsy.
在本文中，我们概述了我们中心以及大多数法国团队所采用的癫痫术前评估的原则、实践和程序。癫痫手术适用于患有严重癫痫且伴有部分性发作的患者。其目的是停止发作，或显著降低发作频率。为此，理论上应切除致痫区和/或切断癫痫发作的传播途径。对这些适应症的讨论不可避免地包括对手术可能导致的功能后遗症（感觉、运动、认知或行为方面）的预先评估。术前评估采用多学科方法，涉及癫痫学家、神经生理学家、神经放射学家、神经心理学家和神经外科医生，分两个阶段进行。第一阶段基于非侵入性检查，包括功能和结构神经影像学、神经心理学评估、发作间期棘波的源定位以及癫痫发作的视频脑电图记录。第二阶段通常是必要的，旨在精确确定致痫区的解剖定位及其与结构性病变的关系。这个侵入性阶段主要基于立体定向脑电图（SEEG）。最后，手术程序必须根据解剖和功能异常的分布及动态情况进行调整，这些异常情况分别界定了每一例癫痫病例。
