Obeid Makram, Wyllie Elaine, Rahi Amal C, Mikati Mohamad A
Adult and Pediatric Epilepsy Program, Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
Eur J Paediatr Neurol. 2009 Mar;13(2):115-27. doi: 10.1016/j.ejpn.2008.05.003. Epub 2008 Jun 30.
The second of this 2-part review depicts the specific approach to the common causes of pediatric refractory epilepsy amenable to surgery. These include tumors, malformations due to abnormal cortical development, vascular abnormalities and certain epileptic syndromes. Seizure freedom rates are high (usually 60-80%) following tailored focal resection, lesionectomy, and hemispherectomy. However, in patients in whom the epileptogenic zone overlaps with unresectable eloquent cortex, and in certain epileptic syndromes, seizure freedom may not be achievable. In such cases, palliative procedures such as callosotomy, multiple subpial transections and vagus nerve stimulation can achieve reduction in seizure severity but rarely seizure freedom. Integration of the new imaging techniques and the concepts of neuronal plasticity, the epileptogenic lesion, the ictal onset, symptomatogenic, irritative, and epileptogenic zones is an expanding and dynamic process that will allow us, in the future, to better decide on the surgical approach of choice and its timing.
本两部分综述的第二部分描述了针对适合手术治疗的小儿难治性癫痫常见病因的具体方法。这些病因包括肿瘤、皮质发育异常导致的畸形、血管异常以及某些癫痫综合征。在进行针对性的局灶性切除、病灶切除术和大脑半球切除术后，癫痫发作缓解率很高（通常为60%-80%）。然而，对于癫痫发作起源区与不可切除的功能区皮质重叠的患者以及某些癫痫综合征患者，可能无法实现癫痫发作缓解。在这种情况下，胼胝体切开术、多处软膜下横切术和迷走神经刺激术等姑息性手术可减轻癫痫发作的严重程度，但很少能实现癫痫发作缓解。新成像技术与神经元可塑性、癫痫病灶、发作起始、症状产生、刺激和癫痫发作起源区等概念的整合是一个不断扩展和动态变化的过程，这将使我们在未来能够更好地确定首选的手术方法及其时机。
