Epilepsy Care in the World: results of an ILAE/IBE/WHO Global Campaign Against Epilepsy survey

PURPOSE: Information about existing resources available within the countries to tackle the huge medical, social, and economic burden caused by epilepsy is lacking. To fill this information gap, a survey of country resources available for epilepsy care was conducted within the framework of the ILAE/IBE/WHO Global Campaign Against Epilepsy. METHODS: The study represents a major collaborative effort involving the World Health Organization (WHO), the International League Against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE). RESULTS: Data were collected from 160 countries representing 97.5% of the world population. The information included availability, role, and involvement of professional and patient associations for epilepsy, epilepsy treatment and services including antiepileptic drugs, human resources involved in epilepsy care, teaching in epileptology, disability benefits, and problems encountered by people with epilepsy and health professionals involved in epilepsy care. The data confirm that epilepsy care is grossly inadequate compared with the needs in most countries. In addition, large inequities exist across regions and income groups of countries, with low-income countries having extremely meager resources. Complete results of this survey can be found in the Atlas: Epilepsy Care in the World. CONCLUSIONS: The data reinforce the need for urgent, substantial, and systematic action to enhance resources for epilepsy care, especially in low-income countries.     

婴幼儿癫痫的外科治疗

目的探讨婴幼儿癫痫外科的手术意义。方法从2002-2005年有12例婴幼儿因海绵状血管瘤(4例)、发育不良神经上皮肿瘤(DNTs)(2例)、Sturge.weber综合征(1例)、半侧巨脑病(2例)、外伤后脑膜脑疤痕(1例)、脑脓肿疤痕组织(1例)、脉络丛乳头瘤(1例);由分别位于额(2例)、颞(4例)、顶(2例)、枕(2例)与额顶及颞顶(各1例)病变所致均为灾难性癫痫。当年龄在9—32(平均21.5)个月龄时做了病变及致痫灶切除/功能性大脑半球切除。癫痫开始于出生后5～20 (平均11.8)个月,每天或每周发作多次,抗痫药物治疗无效。患儿做手术评估是6—22(平均12.8)个月。3例患儿有偏瘫,7例显示有缓慢发展的认知功能减低表现。MRI、PET及V-EEG都证实了病灶及致痛灶。结果手术后无死亡及新的神经症状缺失。8例解除了癫痫(EngelⅠ级);2例罕有发作(EngelⅡ级);2例有值得的(worthwhile)改善(EngelⅢ级),7例认知功能也有改善,3例偏瘫者2例有改善。结论灾难性癫痫婴幼儿仔细选择手术病例,外科可以减轻、解除癫痫的疾苦。     

Comparative Anticonvulsant Activity and Neurotoxicity of 4-Amino-N-(2,6-dimethylphenyl) benzamide and Prototype Antiepileptic Drugs in Mice and Rats

The anticonvulsant and toxic properties of 4-amino-N-(2,6-dimethylphenyl)benzamide, (ADD 75073), were compared with phenytoin (PHT), phenobarbital (PB), ethosuximide (ESM), and valproate (VPA). These compounds were evaluated in mice and rats using well-standardized anticonvulsant test procedures. The results indicate that ADD 75073 is a very potent anticonvulsant in the maximal electroshock seizure (MES) model. The compound was effective in nontoxic doses following intraperitoneal (i.p.) administration in mice and oral administration in both mice and rats. In mice, the i.p. administration of ADD 75073 resulted in an ED50 value of 2.6 mg/kg as compared with a value of 9.5 mg/kg for phenytoin (PHT) in the same assay. Compound ADD 75073 was ineffective in nontoxic doses against all other seizure models examined in this study, and thus has a pharmacologic profile similar to that of PHT.     

Modification of vertical hemispherotomy for refractory epilepsy

Delalande’s vertical hemispherotomy is an innovative evolution of hemispherectomy in minimizing brain resection. We report our modification for this surgical procedure. We modified the original procedure in two aspects for the purpose of less brain resection and confirmation of the complete disconnection. Firstly, all procedures were done via an interhemispheric route instead of a transcortical route. Secondly, we set the anterior disconnection plane as the one that connects the anterior end of the choroidal fissure to the anterior end of the foramen of Monro, instead of the former to the subcallosal area. We applied this modified vertical hemispherotomy to 7 cases. Four cases were children with hemimegalencephaly and other 3 were adults with ulegyric hemisphere. Surgical procedure was completed without complication in all cases. There was no case that required CSF shunting. Seizure outcome was Engel’s class I in 6 and class IV in 1. Postoperative MRI revealed complete disconnection of the affected hemisphere in all patients. We reported our modification of vertical hemispherotomy. Although these are minor modifications, they further minimized brain resection and may serve for less invasiveness of procedure and improvement in completeness of disconnection and its confirmation during surgery.     

Proposed criteria for referral and evaluation of children for epilepsy surgery: recommendations of the Subcommission for Pediatric Epilepsy Surgery

The Commission on Neurosurgery of the International League Against Epilepsy (ILAE) formed the Pediatric Epilepsy Surgery Subcommission in 1998 and charged it with formulating guidelines and recommendations for epilepsy surgery in childhood. Also endorsed by the Commission on Paediatrics, the following document is the consensus agreement after a meeting of 32 individuals from 12 countries in 2003. The panel agreed that insufficient class 1 evidence exists to recommend practice guidelines at this time. Instead, the panel generated criteria concerning the unique features of pediatric epilepsy patients to justify dedicated resources for specialty pediatric surgical centers, suggested guidelines for physicians for when to refer children with refractory epilepsy, and recommendations on presurgical evaluation and postoperative assessments. The panel also outlined areas of agreement and disagreement on which future research and consensus meetings should focus attention to generate practice guidelines and criteria for pediatric epilepsy surgery centers.     

Psychosis after epilepsy surgery: report of three cases

Temporal lobe epilepsy surgery has become a successful alternative in patients with refractory epilepsy. However, the outcome of epilepsy surgery may be affected by the occurrence of postsurgical psychiatric symptoms, such as psychosis. This report describes three cases of refractory temporal lobe epilepsy and hippocampal sclerosis, which, after anterior temporal lobectomy, presented with acute psychosis. One of them had a history of acute psychosis, and all of them met criteria for Cluster A personality disorder (schizoid/schizotypal) during psychiatric assessment prior to surgery. The three cases had a good seizure outcome (Engel I), but, on follow-up during the first year after surgery, developed an acute psychotic episode compatible with schizoaffective disorder; brief psychotic disorder; and a delusional disorder, respectively, according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Treatment with low-dose risperidone was successful.     

103例成人继发性癫癎与病因分析

目的探讨成人继发性癫(?)的病因。方法回顾性分析我院近10年来住院诊断的103例成人继发性癫(?)的临床资料。结果 继发性癫(?)的病因依次为脑血管病(61/103)、脑炎脑膜炎(13/103)、颅内肿瘤(11/103)、代谢性疾病(5/103)、酗酒性肝硬化(5/103)、脑囊虫(2/103)、脑动静脉血管畸形(2/103)、放射性脑病(2/103)和中毒(2/103)。全身性强直-阵挛发作占56.31％,简单部分性发作占26.21％,复杂部分性发作占17.48％,癫(?)持续状态11例。本组继发性癫(?)的各类型卒中,脑血栓形成最多(占50.82％);其次为脑出血(占19.67％);蛛网膜下腔出血(占11.48％);脑栓塞(占11.48％);腔隙性脑梗死最少(占6.55％)。结论 脑血管病是成人继发性癫(?)的最主要病因,正确地诊断继发性癫(?)的病因和发作类型有助于及时正确的治疗。