Hoshida Tohru
National Hospital Organization Nara Medical Center, Shichi-jyo, Nara-city, Nara 630-8053, Japan.
Brain Nerve. 2011 Apr;63(4):313-20.
Surgery is a better treatment option than prolonged medical therapy for patients with temporal lobe epilepsy. Randomized trials on surgery for epilepsy are feasible and appear to yield precise estimates of the effects of surgical treatment. This study includes 56 patients who underwent anterior temporal lobectomy with a mean follow-up of 11.3 years. The probability of achieving complete seizure freedom at 5 and 10 years is 73% and 69%, respectively. Patients who had discrete abnormalities (i.e., tumors, gliosis, or hippocampal sclerosis) before surgery had a significantly higher probability of achieving seizure freedom than did patients without obvious abnormalities. Of the 32 patients, 30 (94%) had the same seizure status as that after surgery at the-10 year follow-up, and 2 (6%) had recurrent seizures. Of the seizure-free patients, 16 (29%) had ceased taking antiepileptic drugs (AEDs) at the 5-year follow-up, and 8 (25%) had ceased taking the drugs at the 10-year follow-up. In this paper, the evolution of the understanding of temporal lobe epilepsy surgery has been discussed. The efficacy of temporal lobe epilepsy surgery remains controversial with regard to the chois of resection method that would provide the best results for seizure freedom and cognitive function. The seizure outcomes obtained after selective amygdalohippocampectomy were found to be similar to those obtained after temporal lobe resection in several studies, and there is considerable evidence for indicating that the neuropsychological outcomes obtained after selective amygdalohippocampectomy are better than those obtained after temporal lobe resection. No significant relationships were found between objective indices of change and subjective ratings for postoperative memory function. A new surgical method based on multiple subpial transections for the hippocampus was developed in 2006. It remains unclear whether mesial resection involving a larger area leads to better seizure outcomes.
对于颞叶癫痫患者，手术治疗比长期药物治疗是更好的选择。关于癫痫手术的随机试验是可行的，并且似乎能精确估计手术治疗的效果。本研究纳入了56例行前颞叶切除术的患者，平均随访11.3年。5年和10年实现完全无癫痫发作的概率分别为73%和69%。术前有明确异常（即肿瘤、胶质增生或海马硬化）的患者实现无癫痫发作的概率显著高于无明显异常的患者。在32例患者中，30例（94%）在10年随访时的癫痫发作状态与术后相同，2例（6%）出现癫痫复发。在无癫痫发作的患者中，16例（29%）在5年随访时停止服用抗癫痫药物（AEDs），8例（25%）在10年随访时停止服用药物。本文讨论了对颞叶癫痫手术认识的演变。关于哪种切除方法能为无癫痫发作和认知功能带来最佳效果，颞叶癫痫手术的疗效仍存在争议。在几项研究中发现，选择性杏仁核海马切除术术后的癫痫发作结果与颞叶切除术相似，并且有大量证据表明，选择性杏仁核海马切除术术后的神经心理学结果优于颞叶切除术。术后记忆功能的客观变化指标与主观评分之间未发现显著相关性。2006年开发了一种基于海马多处软膜下横切术的新手术方法。尚不清楚涉及更大范围的内侧切除术是否会带来更好的癫痫发作结果。
