Jayalakshmi Sita, Vooturi Sudhindra, Gupta Swapan, Panigrahi Manas
Department of Neurology, Krishna Institute of Medical Sciences, Secunderabad, Telangana, India.
Department of Neurosurgery, Krishna Institute of Medical Sciences, Secunderabad, Telangana, India.
Neurol India. 2017 May-Jun;65(3):485-492. doi: 10.4103/neuroindia.NI_1033_16.
Approximately 60% of all patients with epilepsy suffer from focal epilepsy syndromes. In approximately 15% of these patients, the seizures are not adequately controlled with anticonvulsive drugs, and such patients are potential candidates for surgical treatment and majority are children. Epilepsy surgery in children, who have been carefully chosen, can result in either seizure freedom or a marked (>90%) reduction in seizures in approximately two-third of children with intractable seizures. In the multimodality presurgical evaluation approach, sufficient concordance should be established among various independent investigations, thus identifying the location and extent of the epileptogenic zone with a high degree of confidence. Early surgery improves the quality of life and cognitive and developmental outcome of the child. Surgically remediable epilepsies in children should be identified early and include temporal lobe epilepsy with focal lesions, lesional extratemporal epilepsies, hemispherical epilepsies, and gelastic epilepsy with hypothalamic hamartoma, and can be treated by resective or disconnection surgery. Palliative procedures include corpus callosotomy and vagal nerve stimulation for children with diffuse and multifocal epilepsies, who are not candidates for resective surgery. Deep brain stimulation in patients with epilepsy is still under evaluation. For children with "surgically remedial epilepsy," surgery should be offered as a procedure of choice rather than as a treatment of last resort.
约60%的癫痫患者患有局灶性癫痫综合征。在这些患者中，约15%的患者使用抗惊厥药物无法充分控制癫痫发作，这类患者是手术治疗的潜在候选者，且大多数是儿童。精心挑选的儿童进行癫痫手术，约三分之二患有难治性癫痫的儿童可实现无癫痫发作或癫痫发作显著减少（>90%）。在多模态术前评估方法中，各种独立检查之间应建立充分的一致性，从而高度自信地确定致痫区的位置和范围。早期手术可改善儿童的生活质量以及认知和发育结局。儿童中可通过手术治疗的癫痫应尽早识别，包括伴有局灶性病变的颞叶癫痫、颞叶外病灶性癫痫、半球性癫痫以及伴有下丘脑错构瘤的痴笑性癫痫，可通过切除性或离断性手术进行治疗。姑息性手术包括胼胝体切开术和迷走神经刺激术，用于治疗不适合进行切除性手术的弥漫性和多灶性癫痫儿童。癫痫患者的深部脑刺激仍在评估中。对于患有“可手术治疗的癫痫”的儿童，应将手术作为首选治疗方法，而不是作为最后的治疗手段。
