Schmidt Dieter, Löscher Wolfgang
Epilepsy Research Group, Goethestr. 5, D-14163 Berlin, Germany.
Epilepsy Res. 2003 Oct;56(2-3):85-91. doi: 10.1016/j.eplepsyres.2003.10.004.
It is well recognized that two-thirds of patients with drug-resistant temporal lobe epilepsy will be free of disabling seizures with continued medical treatment after temporal resection. Seizure recurrence has been noted during a five-year follow-up in approximately one-third of these seizure-free patients mostly but not exclusively following planned complete discontinuation of antiepileptic drugs (AEDs). This leaves one-third of patients without disabling seizures and without AEDs several years after surgery. Despite improvements in seizure frequency or severity, seizures persist in another third of patients undergoing surgery. Although cure (five years without any seizures and off AEDs) is the ultimate aim of epilepsy surgery, the percentage of patients cured by surgery cannot be well defined at the moment. We need a long-term randomized controlled trial on AED discontinuation in seizure-free patients followed by long-term open extension to determine if only one in three adult patients with drug-resistant temporal lobe epilepsy is cured by surgical intervention.
众所周知，三分之二耐药性颞叶癫痫患者在颞叶切除术后继续接受药物治疗，将不会出现致残性癫痫发作。在大约三分之一术后无癫痫发作的患者中，在五年随访期间观察到癫痫复发，大部分（但并非全部）是在计划完全停用抗癫痫药物（AEDs）之后。这使得三分之一的患者在术后数年既没有致残性癫痫发作，也无需服用AEDs。尽管癫痫发作频率或严重程度有所改善，但另有三分之一接受手术的患者癫痫仍持续存在。虽然治愈（五年无癫痫发作且停用AEDs）是癫痫手术的最终目标，但目前尚无法明确手术治愈患者的比例。我们需要开展一项关于无癫痫发作患者停用AEDs的长期随机对照试验，并进行长期开放扩展研究，以确定耐药性颞叶癫痫成年患者中是否只有三分之一能通过手术干预治愈。
