Schmidt D, Bertram E, Ryvlin P, Lüders H O
Epilepsy Research Group, Goethestr. 5, D-14163 Berlin, Germany.
Epilepsy Res. 2003 Oct;56(2-3):83-4. doi: 10.1016/j.eplepsyres.2003.10.005.
The Third International Spring Epilepsy Research Conference took place in Georgetown, Cayman Islands from April 26 to May 3, 2003. One workshop discussed the impact of epilepsy surgery on seizure outcome and mortality of antiepileptic drug (AED)-resistant temporal lobe epilepsy. This article summarizes the information presented at this workshop. Although two-thirds of adult patients undergoing epilepsy surgery become seizure-free with continued AED treatment, current clinical experience shows that seizure recurrence occurs in one-third of patients when AEDs are withdrawn under medical supervision. Additional seizure recurrence occurring after AED taper, poor drug compliance and even while patients continue on AEDs after surgery leave only approximately one-third of patients cured after temporal lobe resection. Mostly because so many patients prefer to stay on AEDs although they are free of disabling seizures after surgery, a randomised controlled trial of AED discontinuation is needed to determine if in fact only one-third of patients are cured after surgery. Based on the functional anatomy of temporal lobe surgery two hypotheses are presented why only a minority of patients are cured after surgery. The type and the prognostic significance of seizures after surgery is discussed. Recent studies have suggested that successful temporal lobe surgery may be able to normalize the increased standard mortality ratio (SMR) of drug-resistant temporal lobe epilepsy. However, pre-existing differences in SMR between those cured and those not cured by temporal lobe surgery and other unresolved methodological issues make it difficult at present to fully evaluate the impact of surgery on mortality. Future studies are thus warranted to specifically address the impact of temporal lobe surgery on cure and mortality.
第三届国际春季癫痫研究会议于2003年4月26日至5月3日在开曼群岛的乔治敦举行。一个研讨会讨论了癫痫手术对抗癫痫药物（AED）耐药的颞叶癫痫发作结局和死亡率的影响。本文总结了该研讨会上展示的信息。虽然接受癫痫手术的成年患者中有三分之二在继续接受AED治疗后不再发作，但目前的临床经验表明，在医学监督下停用AED时，三分之一的患者会出现癫痫复发。在逐渐减少AED用量后出现的额外癫痫复发、药物依从性差，甚至在患者术后继续服用AED期间，使得颞叶切除术后只有大约三分之一的患者被治愈。主要是因为尽管许多患者术后没有致残性发作，但他们仍倾向于继续服用AED，因此需要进行一项关于停用AED的随机对照试验，以确定实际上术后是否只有三分之一的患者被治愈。基于颞叶手术的功能解剖学，提出了两个关于为什么只有少数患者术后被治愈的假说。讨论了术后发作的类型及其预后意义。最近的研究表明，成功的颞叶手术可能能够使耐药颞叶癫痫升高的标准化死亡率（SMR）恢复正常。然而，颞叶手术治愈者与未治愈者之间预先存在的SMR差异以及其他未解决的方法学问题，使得目前难以全面评估手术对死亡率的影响。因此，有必要进行未来的研究，专门探讨颞叶手术对治愈和死亡率的影响。
