Polkey Charles E
Academic Neurosciences Centre, Institute of Psychiatry, Denmark Hill, London, United Kingdom.
Epileptic Disord. 2003 Jun;5(2):63-75.
The concepts of pathophysiology of epilepsy which underly the non-resective surgical treatment of epilepsy are reviewed. The available techniques, lesioning, disconnection and stimulation are described and reviewed critically. Stereotactic lesioning, popular in the 1950's has been largely abandoned but stereotactic radiosurgery emerges as a useful technique, especially in the treatment of mesial temporal sclerosis. Disconnection by callosotomy has fewer applications than previously and multiple subpial transection (MST) has limited applications. Stimulation is a technique with increasing usefulness. Vagus nerve stimulation(VNS) is an accepted method of treatment with low morbidity and mortality, which improves seizure control in at least 30% of patients, together with concomitant improvements in QOL and economic advantages. Stimulation of deep brain targets in the thalamus, subthalamus and mesial temporal structures is practical. There are indications that this improves seizure control in groups of patients previously un helped by surgery, and this methodology has enormous potential.
本文回顾了癫痫非切除性手术治疗所依据的癫痫病理生理学概念。对现有的技术，即毁损、离断和刺激进行了描述并进行了批判性综述。20世纪50年代流行的立体定向毁损术已基本被摒弃，但立体定向放射外科作为一种有用的技术出现了，特别是在治疗内侧颞叶硬化方面。胼胝体切开术的应用比以前少，而多处软膜下横切术（MST）的应用有限。刺激是一种越来越有用的技术。迷走神经刺激（VNS）是一种公认的治疗方法，发病率和死亡率低，至少能使30%的患者癫痫发作得到控制，同时生活质量也有改善，还有经济优势。刺激丘脑、下丘脑和内侧颞叶结构等深部脑靶点是可行的。有迹象表明，这能改善以前手术未能帮助的患者群体的癫痫发作控制，这种方法具有巨大潜力。
