Cascino Gregory D
Division of Epilepsy, Department of Neurology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.
Epilepsia. 2008 Dec;49 Suppl 9:79-84. doi: 10.1111/j.1528-1167.2008.01930.x.
Epilepsy is a chronic disorder characterized by recurrent and unprovoked seizures (Dreifuss, 1987; Hauser & Hesdorffer, 1990). It is one of the most common neurologic disorders in the adult. The lifetime risk of developing epilepsy is 3.2% (Mattson, 1992). Approximately 90% of the incident cases in adults have symptomatic partial or localization-related epilepsy (Camfield & Camfield, 1996; Hauser & Hesdorffer, 1990; Hauser, 1992). The medial temporal lobe is the most epileptogenic region of the brain (Luby et al., 1995; Jeong et al., 1999; Wiebe et al., 2001). Pathologic lesions underlying the epileptogenic zone include mesial temporal sclerosis (MTS), tumor, vascular anomaly, malformations of cortical development (MCDs), and head trauma (Cascino et al., 1993; Radhakrishnan et al., 1998). The initial response to medication is of prognostic importance (Hauser, 1992). Patients with a remote symptomatic neurologic disease, foreign-tissue lesion, developmental delay, or abnormal neurologic examination are less likely to be rendered seizure-free. The goals of treatment are to render the individual seizure-free without producing antiepileptic drug (AED) toxicity, allowing the individual to become a participating and productive member of society (Engel & Ojemann, 1993). Despite the introduction of "newer" AEDs, nearly one-half of patients with partial epilepsy will not attain a seizure remission with pharmacotherapy (Kwan & Brodie, 2003). This discussion focuses on management of the adult patient with intractable partial seizure disorders that are medically refractory and may not be surgically remediable. It is estimated that 400,000 of the 2 million individuals with partial epilepsy in the United States have a medically refractory partial seizure disorder (Hauser & Hesdorffer, 1990; Hauser, 1992). An estimated 1,500 patients in the United States undergo epilepsy surgery each year. A UK study indicated that 30,000 patients develop epilepsy each year and approximately 6,000 have medically refractory seizures (Lhatoo et al., 2003). However, there are only about 400 epilepsy surgeries performed annually in the UK. Therefore, the number of patients with intractable partial epilepsy that is both medically refractory and possibly not a surgically remediable epileptic syndrome is significant.
癫痫是一种慢性疾病，其特征为反复出现且无诱因的癫痫发作（德赖弗斯，1987年；豪泽与赫斯多弗，1990年）。它是成年人中最常见的神经系统疾病之一。一生中患癫痫的风险为3.2%（马特森，1992年）。成年人中约90%的新发病例患有症状性部分性或局灶相关性癫痫（坎菲尔德与坎菲尔德，1996年；豪泽与赫斯多弗，1990年；豪泽，1992年）。内侧颞叶是大脑中最易引发癫痫的区域（卢比等人，1995年；郑等人，1999年；维贝等人，2001年）。致痫区潜在的病理病变包括内侧颞叶硬化（MTS）、肿瘤、血管异常、皮质发育畸形（MCDs）以及头部外伤（卡斯西诺等人，1993年；拉达克里希南等人，1998年）。药物治疗的初始反应具有预后意义（豪泽，1992年）。患有远期症状性神经系统疾病、异物组织病变、发育迟缓或神经系统检查异常的患者不太可能实现无癫痫发作。治疗的目标是使个体无癫痫发作且不产生抗癫痫药物（AED）毒性，使个体能够成为社会中积极参与且有生产力的一员（恩格尔与奥杰曼，1993年）。尽管引入了“新型”AED，但近一半的部分性癫痫患者通过药物治疗无法实现癫痫发作缓解（关与布罗迪，2003年）。本讨论聚焦于成年难治性部分性癫痫发作障碍患者的管理，这些患者药物治疗无效且可能无法通过手术治愈。据估计，美国200万部分性癫痫患者中有40万患有药物难治性部分性癫痫发作障碍（豪泽与赫斯多弗，1990年；豪泽，1992年）。美国每年估计有1500名患者接受癫痫手术。一项英国研究表明，英国每年有3万人患癫痫，约6000人患有药物难治性癫痫发作（拉托等人，2003年）。然而，英国每年仅进行约400例癫痫手术。因此，患有既药物难治又可能无法通过手术治愈的难治性部分性癫痫的患者数量相当可观。
