Villanueva Vicente, Carreño Mar, Herranz Fernández José Luís, Gil-Nagel Antonio
Epilepsy Unit, Neurology Department, Hospital La Fe, Valencia, Spain.
Neurologist. 2007 Nov;13(6 Suppl 1):S29-37. doi: 10.1097/NRL.0b013e31815c0fbc.
Despite the correct use of antiepileptic drugs, control of seizures is not possible in 20% to 30% of people with epilepsy. This group of patients is considered to suffer from drug-resistant epilepsy, a clinical situation that can be caused by certain syndromes in which surgery can be used to bring the seizures under control.
Determining the suitability of the surgical treatment and the best approach always requires a full assessment, which includes video-electroencephalogram (EEG) monitoring, neuropsychological examination, and structural magnetic resonance imaging. In some patients it may be necessary to perform functional imaging tests and intracranial electrode recordings. These tests make it possible to confirm that the patient does indeed have epilepsy, identify the type of epilepsy, determine the severity of the seizures, and locate the epileptogenic zone. The best surgical results are obtained in patients with small epileptogenic lesions which can be totally resected. Nevertheless, in many patients in whom complete control is not achieved after surgery, the improvement in control of the seizures also has a positive impact on their quality of life. Some surgical techniques (partial resections, corpus callosotomy, subpial transection, electrical stimulation of the vagus nerve, and deep brain stimulation) have a palliative effect.
The aim of this review is to update knowledge on the indications for surgery and electrical stimulation in the management of epilepsy.
尽管正确使用了抗癫痫药物，但仍有20%至30%的癫痫患者无法控制癫痫发作。这组患者被认为患有药物难治性癫痫，这种临床情况可能由某些综合征引起，在这些综合征中可通过手术来控制癫痫发作。
确定手术治疗的适用性和最佳方法始终需要全面评估，包括视频脑电图（EEG）监测、神经心理学检查和结构磁共振成像。在一些患者中，可能需要进行功能成像测试和颅内电极记录。这些测试能够确认患者确实患有癫痫，识别癫痫类型，确定癫痫发作的严重程度，并定位癫痫病灶区。对于可完全切除的小癫痫病灶患者，手术效果最佳。然而，在许多术后未实现完全控制的患者中，癫痫发作控制的改善对其生活质量也有积极影响。一些手术技术（部分切除术、胼胝体切开术、软膜下横切术、迷走神经电刺激和深部脑刺激）具有姑息作用。
本综述的目的是更新关于癫痫管理中手术和电刺激适应证的知识。
