Department of Clinical Neurosciences, Hotchkiss Brain Institute, Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada.
UK National Institute for Health Research University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, London, UK; Epilepsy Society, Chalfont St Peter, UK; Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, Netherlands.
Lancet Neurol. 2016 Aug;15(9):982-994. doi: 10.1016/S1474-4422(16)30127-2.
Findings from randomised controlled trials, along with more than 100 case series and observational studies, support the efficacy and safety of resective surgery and, more recently, non-resective surgical interventions for the treatment of drug-resistant epilepsy in appropriately selected individuals. There is an argument that epilepsy surgery remains underused, but the evidence to support this assertion is at times unclear. Results from longitudinal studies show a stagnant or declining rate of epilepsy surgery over time, despite the evidence and guidelines supporting its use. Some suggest that this stagnation is due to a decreasing pool of eligible surgical candidates, whereas others emphasise the numerous barriers to epilepsy surgery. Strategies exist to increase access to surgery and to improve communication about the effectiveness of this potentially life-changing procedure. Further investigation into the nature and causes of the presumed underuse of epilepsy surgery and the elaboration of strategies to address this treatment gap are necessary and pressing.
随机对照试验的结果，以及 100 多个病例系列和观察性研究，支持了切除术和最近的非切除术手术干预在适当选择的个体中治疗耐药性癫痫的疗效和安全性。有人认为癫痫手术的应用仍然不足，但支持这一说法的证据有时并不明确。纵向研究的结果表明，尽管有证据和指南支持手术的应用，但癫痫手术的比例随着时间的推移呈现停滞或下降趋势。一些人认为这种停滞是由于符合手术条件的患者人数减少所致，而另一些人则强调了癫痫手术面临的众多障碍。存在一些策略可以增加手术机会，并改善对这一可能改变生活的手术的有效性的沟通。进一步调查癫痫手术应用不足的性质和原因，并制定解决这一治疗差距的策略是必要和紧迫的。
