Engel Jerome, Wiebe Samuel, French Jacqueline, Sperling Michael, Williamson Peter, Spencer Dennis, Gumnit Robert, Zahn Catherine, Westbrook Edward, Enos Bruce
Reed Neurological Research Center, Department of Neurology, Los Angeles, CA 90095-1769, USA.
Epilepsia. 2003 Jun;44(6):741-51. doi: 10.1046/j.1528-1157.2003.48202.x.
To examine evidence for effectiveness of anteromesial temporal lobe and localized neocortical resections for disabling complex partial seizures.
Systemic review and analysis of the literature since 1990.
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 1 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 II studies are available.
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.
研究前内侧颞叶和局限性新皮质切除术治疗致残性复杂部分性癫痫的有效性证据。
对1990年以来的文献进行系统综述和分析。
一项关于内侧颞叶癫痫手术治疗的意向性治疗I类随机对照试验发现，随机接受手术评估的患者中，58%（接受手术的患者中64%）在1年末无致残性癫痫发作，10%至15%无改善，而随机接受继续药物治疗的组中无致残性癫痫发作的比例为8%。手术组患者在1年末的生活质量定量评分有显著改善，社会功能有改善趋势，无手术死亡，发病率低。24个IV类颞叶切除术系列得出了基本相同的结果。局限性新皮质切除术也有类似的IV类结果；尚无I类或II类研究。
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的益处大于继续使用抗癫痫药物治疗，且风险至少相当。对于受此类癫痫发作影响的患者，应强烈考虑转诊至癫痫手术中心。需要进一步研究以确定新皮质癫痫是否从手术中获益，以及早期手术干预是否应作为某些可手术治疗的癫痫综合征的首选治疗方法。
