Sugano Hidenori, Arai Hajime
Department of Neurosurgery, Juntendo University.
Neurol Med Chir (Tokyo). 2015;55(5):399-406. doi: 10.2176/nmc.ra.2014-0369. Epub 2015 Apr 28.
Pediatric epilepsy has a wide variety of etiology and severity. A recent epidemiological study suggested that surgery might be indicated in as many as 5% of the pediatric epilepsy population. Now, we know that effective epilepsy surgery can result in seizure freedom and improvement of psychomotor development. Seizure control is the most effective way to improve patients neurologically and psychologically. In this review, we look over the recent evidence related to pediatric epilepsy surgery, and try to establish the optimal surgical timing for patients with intractable epilepsy. Appropriate surgical timing depends on the etiology and natural history of the epilepsy to be treated. The most common etiology of pediatric intractable epilepsy patients is malformation of cortical development (MCD) and early surgery is recommended for them. Patients operated on earlier than 12 months of age tended to improve their psychomotor development compared to those operated on later. Recent progress in neuroimaging and electrophysiological studies provide the possibility of very early diagnosis and comprehensive surgical management even at an age before 12 months. Epilepsy surgery is the only solution for patients with MCD or other congenital diseases associated with intractable epilepsy, therefore physicians should aim at an early and precise diagnosis and predicting the future damage, consider a surgical solution within an optimal timing.
小儿癫痫有多种病因和严重程度。最近一项流行病学研究表明，多达5%的小儿癫痫患者可能需要进行手术。现在，我们知道有效的癫痫手术可以实现无癫痫发作，并改善精神运动发育。控制癫痫发作是从神经和心理方面改善患者的最有效方法。在本综述中，我们审视了与小儿癫痫手术相关的最新证据，并试图为难治性癫痫患者确定最佳手术时机。合适的手术时机取决于待治疗癫痫的病因和自然病史。小儿难治性癫痫患者最常见的病因是皮质发育畸形（MCD），建议对他们尽早进行手术。与手术时间较晚的患者相比，12个月前接受手术的患者往往能改善其精神运动发育。神经影像学和电生理研究的最新进展为在12个月之前的年龄进行非常早期的诊断和全面的手术治疗提供了可能性。癫痫手术是患有MCD或其他与难治性癫痫相关的先天性疾病患者的唯一解决方案，因此医生应致力于早期精确诊断并预测未来损伤，在最佳时机内考虑手术解决方案。
