Sitthinamsuwan Bunpot, Nunta-aree Sarun
Division of Neurosurgery, Department of Surgery, Faculty ofMedicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
J Med Assoc Thai. 2013 Jan;96(1):121-31.
A significant number of epileptic patients suffer from medically refractory epilepsy. Epilepsy surgery is considered an appropriate option for management in such cases.
The surgery endeavors to eradicate disabling seizures with preservation of important neurologic function and improve long-term quality of life.
The authors reviewed medical literatures and researches in regard to principles and presurgical evaluation of epilepsy surgery.
The major concept in surgical therapy for epilepsy is complete resection or disconnection of the epileptogenic zone, which renders the patients seizure-free. Various diagnostic strategies can be comprehensively employed to delineate the epileptogenic zone and to identify the individual at risk for postoperative neurologic morbidity. From a surgical point of view, operative approaches for epilepsy can be categorized into resective surgery and functional surgery. Resective surgery aims to render the patients seizure-free, whereas functional procedure purposes to relieve frequency and severity of disabling seizures. Presurgical evaluation should be conducted by a specialized multidisciplinary team.
Several diagnostic measures and investigations involved in epilepsy surgery will be described in the article. Major steps of preoperative assessment and management algorithm for medically intractable epileptic individuals will be demonstrated as well.
相当数量的癫痫患者患有药物难治性癫痫。癫痫手术被认为是此类病例管理的合适选择。
手术致力于根除致残性癫痫发作，同时保留重要神经功能并改善长期生活质量。
作者回顾了有关癫痫手术原则和术前评估的医学文献及研究。
癫痫外科治疗的主要理念是完全切除或离断致痫区，从而使患者无癫痫发作。可综合采用各种诊断策略来界定致痫区，并识别术后发生神经功能障碍风险的个体。从手术角度来看，癫痫手术方法可分为切除性手术和功能性手术。切除性手术旨在使患者无癫痫发作，而功能性手术旨在减轻致残性癫痫发作的频率和严重程度。术前评估应由专业的多学科团队进行。
本文将描述癫痫手术中涉及的几种诊断措施和检查。还将展示药物难治性癫痫患者术前评估和管理流程的主要步骤。
