成年难治性癫痫患者立体定向术后生活质量的调查分析

目的调查分析立体定向手术治疗对成年难治性癫痫患者生活质量的影响。方法对92例无明确致痫灶的成年难治性癫痫患者进行立体定向手术治疗,采用症状自评量表(SCL-90)、癫痫患者生活质量量表-31(QOLIE-31)在手术前及手术后半年、1年、2年、3年、4年、5年对患者进行连续评估。结果尽管部分患者术后癫痫症状不能完全控制,但患者总的生活质量在手术后各阶段均较术前明显提高。手术效果EngelⅠ级患者术后各时间段的生活质量优于Ⅱ~Ⅳ级患者的生活质量。术前具有明显精神症状患者术后各时间段的生活质量与术前无精神症状患者的术后生活质量比较无明显差异。结论对于经术前综合评估不能确定致痫灶,特别是伴有明显精神症状的难治性癫痫患者,立体定向手术治疗是一种有效的治疗手段,可显著改善这部分患者的生活质量。     

难治性颞叶癫痫术后生活质量的评估

目的调查药物难治性颞叶癫痫术后患者生活质量的改善情况,评估手术对该类患者生活质量的影响。方法将自理能力、学习能力、工作能力、经济收入四个指标作为生活质量的评定标准,对比168例药物难治性颞叶癫痫患者手术前后生活质量的变化,并进行统计学分析。结果 168例药物难治性颞叶癫痫患者经过严格的术前评估均行前颞叶切除,随访1-3年,术后生活质量较术前明显改善,有统计学意义。结论药物难治性颞叶癫痫患者术后生活质量明显改善,手术显示出良好的性价比,有手术指证的患者应积极手术治疗。     

胚胎发育不良性神经上皮肿瘤的致痫灶处理

目的 探讨胚胎发育不良性神经上皮肿瘤(DNT)伴药物难治性癫痫患者的外科手术治疗方法.方法 回顾性分析了第三军医大学新桥医院神经外科采用外科手术治疗14例此类患者的经验.术前和术中均进行致痫灶定位,术中在切除肿瘤的同时一并处理肿瘤外致痫灶.结果 14例患者肿瘤均得到全切,未行放疗和化疗,无肿瘤复发及恶性转化.11例患者癫痫发作得到完全控制(Engel Ⅰ级),2例患者稀少发作(Engel Ⅱ级),1例患者术后仍有频繁癫痫发作,再次手术切除肿瘤周围致痫灶后癫痫得到完全控制.结论 DNT应当按照皮质发育障碍来处理,除切除肿瘤外,积极处理肿瘤外致痫灶可获得较佳的癫痫控制结果.     

左乙拉西坦添加治疗对难治性部分性癫痫患者生活质量影响的研究

目的：评价新型抗癫痫药物左乙拉西坦（Lev）作为添加治疗对难治性部分性癫痫患者生活质量的影响。方法：43例确诊有癫痫部分性发作的成年患者随机分为两组：Lev治疗组与安慰剂组,Lev治疗16周后比较两组的有效率和不良反应,并用QOLIE-31量表对两组癫痫患者进行生活质量评定,所有患者在转入Lev开放性治疗6个月后再次进行QOLIE评估。结果：16周治疗期末Lev组癫痫部分性发作的治疗有效率明显高于安慰剂组,两组不良反应的发生率相当;Lev组生活质量明显高于安慰剂组,两组患者转入开放性治疗6个月后,生活质量均显著改善。结论：Lev作为添加用药治疗成人难治性部分性癫痫发作,显著减少发作频率、安全耐受性较好,能够提高癫痫患者的生活质量。     

立体定向颅内脑电图在难治性癫痫治疗中的价值(附30例临床分析)

目的探讨立体定向颅内脑电图技术(SEEG)在难治性癫痫术前评估及癫痫灶定位中的作用与价值。方法回顾性分析中国医科大学航空总医院癫痫中心对于头皮脑电、电子计算机断层扫描(computed tomography, CT)、头颅磁共振(MRI)难以定位的药物难治性癫痫患者30例,根据其临床和术前影像学检查结果,设计SEEG方案并进行电极置入,长程记录发作3次以上并给予电刺激,结合发作间期及发作期深部脑电图确定致痫灶,手术切除后随访患者发作改善情况。结果 15例患者监测到局灶性发作,13例监测到区域性发作,2例患者监测到频繁全面性发作,30例患者均无电极植入后并发症,其中28例参照颅内脑电图结果行外科手术治疗,术后随访6～18个月,癫痫发作消失18例,5例缓解90%,5例缓解50%以上,无手术并发症。结论立体定向颅内脑电图在头皮脑电及磁共振难以明确致痫灶的难治性癫痫治疗中有重要的地位,为癫痫外科提供定位诊断价值,提高手术效果,减少手术并发症。     

神经导航手术治疗难治性额叶辅助运动区癫痫1例并文献综述

目的探讨难治性额叶辅助运动区癫痫的手术治疗。方法结合国内外文献,分析1例采用神经导航手术治疗难治性额叶辅助运动区癫痫。结果患者术后无明显神经系统缺损症状,术后随访6个月无发作。结论药物难治性额叶癫痫可选择手术治疗,神经导航系统的空间立体定向,可提高致痫灶切除的精准性,减少手术损伤。     

小儿难治性癫痫的手术治疗及病理结果分析

目的 探讨小儿药物难治性癫痫的外科治疗时机及病理结果与疗效的关系.方法 对71例小儿难治性癫痫进行手术治疗,术后至少随访1年,根据Engel预后分级评估手术效果.结果 术后随访的难治性癫痫患儿中,无癫痫发作(Engel Ⅰ级)的45例(63％),其中全切除32例,次全切除13例,仍有癫痫发作(EngelⅡ～Ⅳ级)的26例(37％),效果与致痫灶切除程度密切相关(P＜0.05).病理结果:局灶性脑皮质发育不良31例,低级别肿瘤18例,瘢痕脑回13例,小脑回畸形6例,结节性硬化3例,其中双重病理9例.无手术死亡和永久性并发症.结论 早期外科手术对小儿难治性癫痫是一种安全有效的治疗方式,其病理类型与手术结果存在一定相关性.     

难治性癫痫的偶极子定位手术治疗

目的：探讨利用偶极子三维颅内癫痫病灶定位系统对难治性癫痫病患者致痫灶定位，进行外科手术治疗的效果。方法：对1999年8月至2001年6月在我院实施的259例难治性癫痫患者运用偶极子三维颅内癫痫病灶定位系统对难治癫痫患者致痫灶进行术前精确定位，指导采用相应多种方式手术治疗，并探讨其疗效及随访结果。结果：随访6-22月者180例，疗效满意112例，显著改善（发作减少75%以上）36例，良好（发作减少50%以上）22例，疗效差10例。总有效率为94%。显效率82%，未发现任何远期功能损害。结论：偶极子三维颅内癫痫病灶定位系统是目前用于明确癫痫病灶定位较为先进的方法，准确指导手术，可明显提高手术效果，并减少并发症的产生。     

迷走神经刺激治疗癫痫新进展

癫痫是神经系统最常见的病症之一,严重影响患者、家庭和社会。约1/3的患者为药物难治性癫痫,其中只有一部分适合行手术治疗,其余患者可考虑行迷走神经刺激术(VNS)治疗。迷走神经刺激术是许多癫痫发作类型和癫痫综合征的有效治疗方法,是治疗药物难治性癫痫最常用的神经调控技术。迷走神经刺激术治疗难治性癫痫已有30 a历史,本文对近年来在儿童、青年、成年难治性癫痫中的有效性、不良反应、生活质量及花费问题,以及该疗法的一些仍需探讨的问题做一综述。     

丘脑核团电刺激在癫痫中的应用

正癫痫是一种严重威胁人类健康的神经系统疾病,据世界卫生组织统计,全球约有5000万癫痫患者~([1]),其中约30%为药物难治性癫痫~([2])。外科手术切除致痫灶是药物难治性癫痫常用的治疗方法,能缓解大部分患者的症状,当患者不符合切除性手术的适应证或术后发作无缓解时,脑深部     

传统抗癫疒间药物与托吡酯对成年癫疒间患者生活质量影响的对比研究

目的 探讨传统抗癫癎药物(AEDs)与托吡酯(TPM)对成年癫癎患者生活质量(QOL)的影响。方法 102例临床确诊的成年癫癎患者随机分为AEDs组和TPM组,井用QOL IE-30表对102例癫癎患者和62名正常人(对照组)进行评定。结果 AEDs组较对照组QOL明显降低(P<0.05),表现惧怕发作,对日常生活不满意,情绪差,精力不足,认知功能下降,对长期服用抗癫癎药物的顾虑较多,社交、工作受限等;而TPM组的QOL虽然低于对照组(P<0.05),但在前5项的评分中明显高于AEDs组(P<0.05)。TPM组的发作频率明显低于AEDs组(P<0.05)。发作频率对癫癎患者QOL的影响较大,癫癎发作越频繁,QOL越差。结论 成年癫癎患者的QOL较正常人显著降低,TPM能提高癫癎患者的QOL,其改善QOL的作用主要是通过控制发作实现的。因此,合适的药物控制癎性发作是提高癫癎患者QOL的关键。     

癫癎患者生活质量及其影响因素的研究

目的研究癫痫间患者的生活质量及其影响因素。方法采用癫痫间患者生活质量量表-31(QO-LIE-31)对56例确诊的癫痫间患者和46例对照者进行评价。结果癫痫间组患者QOL各项得分均显著低于对照组(P<0.05);全身性强直-阵挛发作(GTCS)和复杂部分性发作(CPS)患者QOL各项得分无显著差异(P>0.05);伴有抑郁的癫痫间患者在对发作的担忧、情绪健康、精力/疲乏和总体健康水平方面低于不伴有抑郁的癫痫间患者(P<0.05);服用1种抗癫痫间药物(AED)的患者与服用1种以上的患者比较,在对发作的担忧、综合生活质量、情绪方面、药物的影响以及总体健康水平方面得分显著降低(P<0.05)。结论癫痫间患者生活质量显著降低,抑郁和服用多种AED对生活质量影响较大。     

传统抗癫痫药物和妥泰对成年癫痫患者生活质量的影响

目的 评价传统抗癫痫药物和妥泰对成年癫痫患者生活质量的影响。方法 102例临床新确诊的成年癫痫患者被随机分为两组：一组予以传统抗癫痫药物单药系统治疗(AEDs组)，另一组予以妥泰单药治疗(TPM组)。1个月后比较两组的发作频率和不良反应。并用QOLIE-30表对这102例癫痫患者进行生活质量评定。结果 TPM组的发作频率和不良反应均明显低于AEDs组，而生活质量总分明显高于AEDs组，尤其在前五项的评分中更加明显。结论 TPM能提高癫痫患者的生活质量，其改善生活质量的作用主要是通过控制发作和减轻不良反应实现的。     

Depression,anxiety and quality of life in parents of children with epilepsy

0bjectives – To assess the impact of childhood epilepsy on parental quality of life (QOL) and psychological health, and to investigate possible correlations between parental QOL and background variables as well as parental anxiety and depression. Subjects and methods – Parents having an epileptic child (n = 263) and parents having a healthy child (n = 270) were enrolled. Groups were in balance for background variables. Short‐Form Health Survey (SF‐36) Questionnaire, Zung Depression Scale (ZDS) and Zung Anxiety Scale (ZAS) were applied to all parents. Patients were divided into the first visit group (newly diagnosed epilepsy) and follow‐up visit group. Results – The parents of children with epilepsy had significantly lower QOL scores in SF‐36 for all subscales and higher levels of depression and anxiety by using ZDS and ZAS. The factors correlated with parental QOL were seizure control, visit status, anxiety, depression, employment, cost of epilepsy, status epilepticus, drug side effect and age of parents. Conclusions – Childhood epilepsy has a severe impact on parental QOL and psychological health, and recognition of possible correlations between parental QOL and background variables will be helpful to improve parental QOL.     

Quality of life of patients with epilepsy (Hungarian survey).

We assessed the quality of life (QOL) of patients with epilepsy using the Quality of Life in Epilepsy Inventory (QOLIE-31). As the first step we compared our results with the data from an American survey in order to validate the test in Hungary. The results show that the Hungarian values were lower but that they followed the same trends as the American data. There was only one controversial result in the question-group of the 'the effects of treatment', which could be explained by the differences in habits and conventions, opportunities and expectations between Hungarian and American epileptic patients. We found significant differences in many aspects of quality of life with respect to (a) gender (general quality of life, seizure worry), (b) pharmacological treatment form (cognitive functions, medication effects, total score and social and role functioning) and (c) economic activity of patients (cognitive functions, emotional well-being, energy/fatigue, medication effects, overall quality of life, overall scores, seizure worry, social and role functioning). We have tried to explain the differences found by taking either the characteristics of epilepsy or the social background of the epileptic patient into consideration. Based on previous knowledge we have tried to define the situations where the assessment of quality of life for people with epilepsy, may be beneficial to their core.     

A structured, nurse-led intervention program improves quality of life in patients with epilepsy: a randomized, controlled trial

We tested the hypothesis that structured epilepsy nursing improves quality of life (QOL). One hundred fourteen adult patients with uncontrolled epilepsy were randomly assigned to either an intervention group or a control group. The intervention group was offered an interactive, 1-day group education program followed by extended nurse follow-up and counseling. The nurse was present at as many outpatient consultations as possible and performed repeated consultations by telephone. All patients completed the QOLIE-89 before randomization and after 2 years. QOL was significantly improved from inclusion to completion of study in the intervention group (P=0.019), mainly in the subitems for Health Discouragement (P=0.01), Medication Effects (P=0.035), and Physical Role Limitations (P=0.05). To our knowledge, this is the first study to demonstrate a significant effect of a structured nurse-led intervention program in QOL of patients with epilepsy.     

颞叶癫痫患者生活质量及其影响因素的研究

目的观察颞叶癫痫患者生活质量的状况,并探讨社会人口学、临床发作以及焦虑、抑郁等因素对患者生活质量的影响。方法对93例颞叶癫痫患者和100名健康对照者进行生活质量量表-31(QOL-31)、Zung氏抑郁自评量表(SDS)和Zung氏抑郁自评量表(SAS)测定。结果颞叶癫痫患者生活质量各项得分均明显低于健康对照组(P<0.001),焦虑和抑郁自评量表得分均明显高于健康对照组(P<0.001)。多元逐步回归分析显示,影响生活质量的主要因素为抑郁、发作严重程度、焦虑和病程。结论颞叶癫痫患者生活质量存在不同程度下降。发现和治疗颞叶癫痫患者的抑郁、焦虑等精神心理问题以及选择合理治疗方法、控制癫痫发作是提高生活质量、改善预后的重要前提。     

A Psychosocial Approach to Epileptic Patients

Summary: A psychoeducational approach was taken with 174 epileptic patients. Using this approach, no family problems were recognized among patients with idiopathic generalized epilepsy (IGE) or among those with symptomatic generalized epilepsy (SGE). However, 11 patients with temporal lobe epilepsy (TLE) and 1 patient with non-temporal lobe epilepsy (non-TLE) did exhibit family problems indicating that such problems involving IGE or SGE cases can be prevented through educational programs using a psychoeducational approach. This fails, however, to prevent such problems for TLE or non-TLE cases. Furthermore, small group psychotherapy was given to 10 patients with intractable TLE. They were directed to make self-evaluations regarding therapeutic factors originally introduced by Yalom but specially modified for these particular patients. Relatively high evaluations were given on every factor when compared with the results of individual psychotherapy. These results point out the importance of providing such psychotherapeutic approaches as group psychotherapy and self-help groups in addition to educational programs in order to enhance the quality of life (QOL) of epileptic patients and their families.