Manaka Shinya, Ishijima Buichi, Mayanagi Yoshiaki
Manaka Hospital, Odawara, Kanagawa, Japan.
Neurol Med Chir (Tokyo). 2003 Dec;43(12):589-600; discussion 600. doi: 10.2176/nmc.43.589.
The risk of epileptic seizures after craniotomy is extremely important but the incidence of postoperative epilepsy varies greatly, depending on the patient's conditions such as primary diseases, severity of surgical insult, and pre-existing epilepsy. Animal studies suggest that neurosurgical insults lead to seizures by two different mechanisms: One mechanism is mediated by free radical generation and the other by impaired ion balance across the cell membrane caused by ischemia or hypoxia. Conventional antiepileptic agents such as phenytoin, phenobarbital, carbamazepine, and valproic acid are promising for the prevention of early seizures, but the effect in preventing postoperative epilepsy is still controversial. Studies on the prophylactic effect of newer antiepileptic agents in craniotomized patients were very limited. Zonisamide, an antiepileptic agent with antiepileptogenic, free radical scavenging and neuroprotective actions in experimental animals, showed promising effects against postoperative epilepsy in a randomized double blind controlled trial. Prophylactic treatment for craniotomized patients significantly prevented the development of partial seizures during the follow-up period. Most recent studies have not supported the prophylactic use of antiepileptic agents in craniotomized patients, but further studies are required.
开颅术后癫痫发作的风险极为重要，但术后癫痫的发生率差异很大，这取决于患者的病情，如原发性疾病、手术损伤的严重程度以及既往是否存在癫痫。动物研究表明，神经外科手术损伤通过两种不同机制导致癫痫发作：一种机制由自由基生成介导，另一种由缺血或缺氧引起的细胞膜离子平衡受损介导。传统抗癫痫药物，如苯妥英、苯巴比妥、卡马西平和丙戊酸，有望预防早期癫痫发作，但在预防术后癫痫方面的效果仍存在争议。关于新型抗癫痫药物对开颅患者预防作用的研究非常有限。唑尼沙胺是一种在实验动物中具有抗癫痫发生、清除自由基和神经保护作用的抗癫痫药物，在一项随机双盲对照试验中显示出对术后癫痫有良好效果。对开颅患者进行预防性治疗在随访期间显著预防了部分性癫痫发作的发生。最近的研究不支持对开颅患者预防性使用抗癫痫药物，但仍需要进一步研究。
