Department of Pediatrics, Armed Forces Medical College, Pune, India.
Department of Pediatrics, Lady Hardinge Medical College, New Delhi, 110001, India.
Indian J Pediatr. 2020 Dec;87(12):1062-1069. doi: 10.1007/s12098-019-03164-3. Epub 2020 Feb 11.
Nearly 20-40% of patients with epilepsy are likely to have drug resistant epilepsy (DRE). Add-on antiseizure drugs do not produce optimal seizure control in these patients. Among the non-pharmacological options, only resective surgery is curative. However, a large majority of patients are not candidates for resective epilepsy surgery. For these children with DRE, non-pharmacological non-surgery "palliative" options should be considered early than late. These include dietary therapies and neuromodulation. While there are numerous clinical trials supporting the efficacy of dietary therapies (viz ketogenic diet, modified Atkins diet and low glycemic index therapy), the evidence for neuromodulation is still evolving. Neuromodulation techniques include vagal nerve stimulation, deep brain stimulation, and transcranial magnetic stimulation. Each of the options, whether diet or neuromodulation, has its own advantages, disadvantages and adverse events profile. These have to be considered and discussed with the family before deciding the modality being chosen.
大约 20-40%的癫痫患者可能患有耐药性癫痫（DRE）。在这些患者中，添加抗癫痫药物并不能达到理想的控制癫痫发作的效果。在非药物治疗方法中，只有切除性手术是根治性的。然而，绝大多数患者不符合切除性癫痫手术的条件。对于这些患有 DRE 的儿童，应该尽早而不是晚些考虑非药物非手术的“姑息性”选择。这些选择包括饮食疗法和神经调节。虽然有许多临床试验支持饮食疗法（即生酮饮食、改良阿特金斯饮食和低血糖指数疗法）的疗效，但神经调节的证据仍在不断发展。神经调节技术包括迷走神经刺激、深部脑刺激和经颅磁刺激。无论是饮食疗法还是神经调节，每种选择都有其自身的优缺点和不良事件特征。在选择治疗方式之前，必须与患者家属一起考虑和讨论这些因素。
