Forcadas-Berdusán M I
Servicio de Neurología, Hospital de Cruces. Barakaldo, Vizcaya, España.
Rev Neurol. 2002 Sep;35 Suppl 1:S144-50.
In this paper we review alternative non pharmacological treatments for patients with epilepsy, both focal and generalized, which are resistant to the pharmacological treatment normally used.
Vagal nerve stimulation (VNS) is a recently used palliative technique whose mechanism is not clearly understood. We analyze the clinical trials reported to date and the main indications and contra indications. Although the ketogenic diet (KD) has been used since the 1920s, recently there has been renewed interest in using it. Several papers have been published describing its use in children with epilepsy which was difficult to control. The complex metabolic and endocrine aspects of this type of diet make it difficult to select patients who may benefit from it. Gamma knife surgery is a new technique which has been discussed in this paper since it has been recently used in cases of refractory epilepsy, especially temporal medial epilepsy and hypothalamic hamartomas.
VNS and KD are alternative treatments which may be used in patients whose condition cannot be satisfactorily controlled by pharmacological treatment and are not candidates for the surgery of epilepsy. Gamma knife surgery is a surgical technique which has recently been introduced for the treatment of these patients.
在本文中，我们回顾了针对局灶性和全身性癫痫且对常规使用的药物治疗耐药的患者的替代性非药物治疗方法。
迷走神经刺激（VNS）是一种最近使用的姑息治疗技术，其机制尚不清楚。我们分析了迄今为止报道的临床试验以及主要适应证和禁忌证。尽管生酮饮食（KD）自20世纪20年代就已被使用，但最近人们对其使用又重新产生了兴趣。已经发表了几篇论文描述其在难以控制癫痫的儿童中的应用。这种饮食类型复杂的代谢和内分泌方面使得难以选择可能从中受益的患者。伽玛刀手术是一种新技术，本文对其进行了讨论，因为它最近已用于难治性癫痫病例，尤其是内侧颞叶癫痫和下丘脑错构瘤。
VNS和KD是替代性治疗方法，可用于那些病情无法通过药物治疗得到满意控制且不适合进行癫痫手术的患者。伽玛刀手术是一种最近引入用于治疗这些患者的手术技术。
