Ramantani Georgia, Holthausen Hans
Child Neurology, University Children's Hospital, Steinwiesstrasse 75, 8032 Zurich, Swiss Epilepsy Center, Bleulerstrasse 60, 8008 Zurich, Switzerland.
Neuropediatric Clinic and Clinic for Neurorehabilitation, Epilepsy Center for Children and Adolescents, Schoen-Klinik Vogtareuth, Krankenhausstrasse 20, 83569, Vogtareuth, Germany.
Epileptic Disord. 2017 Jun 1;19(2):117-136. doi: 10.1684/epd.2017.0916.
The risk of unprovoked seizures in population-based cohorts of cerebral infection survivors is 7-8% in developed countries, rising to considerably higher rates in resource-poor countries. The main risk factors for epilepsy after cerebral infection, besides acute seizures, are infection-associated brain lesions and status epilepticus during the acute phase. Despite the high prevalence of pharmacoresistant epilepsies after cerebral infections, especially in patients with MRI-identifiable lesions, only a small minority undergoes epilepsy surgery. However, excellent surgical candidates are particularly those with a history of meningitis or encephalitis in early childhood, hippocampal sclerosis on MRI, as well as a history, seizure semiology, and EEG-findings compatible with the diagnosis of a mesial temporal lobe epilepsy syndrome. More challenging are patients with neocortical/extratemporal lobe epilepsies post cerebral infection. Finally, patients with a severe hemispheric injury with contralateral hemiparesis are candidates for hemispherectomy/hemispherotomy. This review attempts to shed some light on this frequent cause of symptomatic focal epilepsy, with an emphasis on the chances offered by epilepsy surgery.
在发达国家，以人群为基础的脑感染幸存者中，无诱因癫痫发作的风险为7%-8%，在资源匮乏国家这一比例则大幅上升。脑感染后癫痫的主要危险因素，除急性发作外，还有感染相关的脑损伤和急性期癫痫持续状态。尽管脑感染后药物难治性癫痫的患病率很高，尤其是在MRI可识别病变的患者中，但只有一小部分人接受癫痫手术。然而，优秀的手术候选者尤其包括那些在幼儿期有脑膜炎或脑炎病史、MRI显示海马硬化，以及病史、发作症状学和脑电图结果符合内侧颞叶癫痫综合征诊断的患者。脑感染后新皮质/颞叶外癫痫患者的情况更具挑战性。最后，患有严重半球损伤并伴有对侧偏瘫的患者是半球切除术/大脑半球切开术的候选者。本综述试图阐明这种常见的症状性局灶性癫痫病因，重点关注癫痫手术提供的机会。
