难治性癫痫手术治疗15例的体会

目的探讨难治性癫痫手术治疗方面的相关问题。方法通过对15例难治性癫痫患者的发作症状学分析、视频脑电检查、头颅磁共振检查等手段进行综合分析及术前评估后定位致痫灶,实施手术。术中进行脑电监测直至异常放电明显减少或消失。其中13例患者一次手术完成,2例患者先行埋藏电极后二次手术完成。术后随访半年-2年,了解癫痫发作情况。结果按照Engel分级,Ⅰ级和Ⅱ级视为显效,Ⅲ级为好转,Ⅳ级为无效。本组显效14例(93.3%),好转1例(6.6%),无效0例。结论若选择癫痫病例得当,手术治疗是一种安全、有效的治疗方法。     

36例难治性癫痫手术治疗及术后影响因素

目的总结难治性癫痫的外科治疗经验,分析手术治疗的效果以及手术影响因素。方法术前运用CT、MRI和脑电图等检查对癫痫病灶进行精确定位,全麻下行开颅癫痫病灶切除和变性脑组织切除,并依据患者不同情况结合其他外科治疗方法。手术在显微镜下进行,采用皮层脑电图和深部脑电图监测。结果术后2周内有7例患者出现语言功能障碍,5例患侧肌张力下降,2周后均逐渐恢复。术后随访1～4a,36例治疗后满意3例（8．3％）,显著改善18例（50．0％）,良好11例（30．6％）,较差4例（11．1％）,没有无改善病例。结论应用外科手术方法治疗难治性癫痫,根据癫痫病灶部位的不同,应用不同的手术方式,可以收到良好的治疗效果。     

难治性癫痫手术预后因素分析

目的 探讨性别、诱因、发作类型、是否存在先兆、致痫灶部位、致痫灶范围、好发时段、年龄、初次发病年龄、病程、发作持续时间、发作频率、总手术时间、颅内手术时间、术中失血量等15种因素与难治性癫痫患者手术治疗后癫痫发作控制情况的关系。方法 分析359例难治性癫痫患者的临床资料、手术方案和术后随访资料。结果 本组所有病例随访1年以上．术后效果满意率为94．15％。单因素分析提示：诱因、发作类型、是否存在先兆、致痫灶部位、致痫灶范围、好发时段、初次发病年龄、病程、发作频率等因素与术后效果有显著性关系，性另q、年龄、发作持续时间、总手术时间、颅内手术时间、术中失血量等因素与术后效果无显著性关系。Logistic回归分析发现：有诱因、全身性发作、睡眠中好发、初次发病年龄轻、病程长可能为术后癫痫控制效果不满意的独立危险因素。结论 手术治疗难治性癫痫多可获得满意的效果。无发作诱因、部分性发作、无先兆、颞叶癫痫、单脑叶癫痫患者手术效果更好，睡眠中多发作、初次发病年龄轻、病程长、发作频率高者手术效果相对不满意。颞叶癫痫、单脑叶癫痫、儿童癫痫应成为外科治疗的重点。所有难治性癫痫一旦诊断成立、定位明确、可以手术，皆宜及早手术治疗。     

难治性癫痫手术治疗进展

磁共振成像技术与电生理技术为难治性癫痫的诊断提供了有力的技术支持。神经导航技术、手术中磁共振成像技术等提高了操作的准确性。其他新技术例如软膜下多重横切术、迷走神经直接或间接刺激术也有效应用于临床。通过研究经典神经外科切除手术与采用新技术在治疗上的差异,分析了目前难治性癫痫手术的治疗结果,证实手术治疗对于药物难治性癫痫患者是安全有效的。     

难治性癫痫胼胝体切开术后手术再评估

胼胝体切开术(corpus callosotomy,CC)作为一种姑息性的难治性癫痫外科手术,在临床上已得到普遍应用。随着现代科学技术的发展,癫痫外科手术评估的手段也越来越进步,人们对根治性手术的渴望也越来越强烈,本文就胼胝体切开术后根治性手术的再评估作一简要综述。     

24例难治性颞叶癫痫手术患者病例分析

目的 了解难治性颞叶癫痫手术治疗的现状和预后效果.方法 回顾性分析2011年4月-2014年6月于淄博昌国医院经手术治疗且临床及随访资料完整的24例难治性颞叶癫痫手术患者,其中男14例,女10例.年龄16～44岁,平均(24.40±6.26)岁,平均病程(12.50±8.42)年.分析患者的临床特点和预后情况.结果 2...     

手术治疗脑灰质移位继发难治性癫痫1例

灰质移位是脑神经元移行异常的一种，多以癫痫为首发症状，部分伴有较少发育迟缓和智力障碍。目前国内手术治疗该病的报道较少，我科手术治疗脑灰质移位继发难治性癫痫1例，手后癫痫完全缓解，报告如下。     

难治性癫痫显微手术治疗22例分析

我院1997年1月～2001年12月，对22例有颅内病灶的难治性癫痫施行显微手术，取得较满意的效果，现报告如下：     

脑功能区难治性癫痫的手术治疗

目的探讨开颅手术对功能区难治性癫痫的疗效。方法84例脑功能区难治性癫痫患者中,采用局部癫痫灶切除 多处软膜下横纤维切断术者29例,癫痫病灶切除 多处软膜下横纤维切断 前颞叶切除33例,癫痫病灶切除 多处软膜下横纤维切断 胼胝体前1/3切开22例。记录术后早期和9￣30个月临床观察及随访结果。结果术后早期16例患者出现一侧肢体肌力减弱,23例患者术后2￣3d出现失语,经治疗均在5￣10d内恢复。出院后随访9￣30个月,完全无发作65例,发作次数减少50%以上11例,发作减少50%以下6例,2例癫痫发作与术前相同。术前有14例言语功能障碍,17例有一侧肌力下降,术后均有不同程度的改善和恢复。结论术后疗效表明局部癫痫灶切除 多处软膜下横纤维切断术和癫痫病灶切除 多处软膜下横纤维切断 前颞叶切除的手术疗效优于癫痫病灶切除 多处软膜下横纤维切断 胼胝体前1/3切开手术方式的疗效。     

难治性癫痫的手术治疗(附21例临床报道)

目的探讨癫痫的手术治疗和脑电图在癫痫手术中的作用.方法对21例经抗痫药物治疗无效或效果不佳的癫痫病人在皮质脑电图和深部脑电图的监测下进行手术治疗.结果21例均有效,无死亡和致残病例.随访到17例,满意11例,显著改善4例,良好1例,效果差1例.结论癫痫手术治疗均可获得一定的效果.脑电图在癫痫手术治疗中起着重要的作用.     

颅内电极在外科治疗难治性癫痫中的应用——附20例临床报道

目的探讨颅内电极在外科治疗难治性癫痫中的应用。方法男12例,女8例,无创检查均不能准确定侧、定位。采用硬膜下和(或)深部电极进行长程视频脑电监测,电极放置部位、数量根据发作症状学和无创检查结果确定,其中皮层条状电极16例,皮层条状电极+深部电极2例,皮层条状电极+栅状电极2例。其中7例于埋藏后第4～12天行慢性电刺激以定位皮层功能区和(或)诱发癫痫发作。结果本组20例埋藏后监测2～21天,平均8.6天;17例获得定侧定位,1例明确为双侧起源,2例因其它原因被终止监测而无法定侧定位;17例行切除性手术,1例行胼胝体前部切开术,术后无一例感染。对随访6个月以上的17例作评估,满意15例(88.2%),显著改善2例。结论颅内电极能够用于定侧定位致痫灶及脑功能区,从而提高手术效果、降低神经功能障碍的发生。     

Seizure outcome for surgery of extratemporal epilepsy

Over a 10-year period, 64 surgical operations were carried out on 55 patients suffering from refractory extratemporal epilepsy. Patient class outcome 3 years after the final surgical procedure showed that 9 patients (16%) were completely seizure free and 21 patients (38%) had less than a 50% reduction in seizure outcome. Corpus callosal section as a surgical procedure had the highest percentage (57%) of patients with a class 4 outcome. Corpus callosotomy as a final operation resulted in reduction in frequency and severity of ‘drop attacks’ in all patients. Gliosis without atrophy was the most common histopathology. There were no deaths as a result of surgery, although 4 patients died postsurgery; 2 died in status epilepticus. Multiple lobectomy was the most successful surgical procedure, with a Prognostic Index of 2.0, followed by 2.5 for extratemporal tumour resection. Corpus callosotomy and cystectomy had a Prognostic Index of 3.3 and 3.1, respectively.     

维拉帕米治疗难治性癫痫机制的研究

目的 研究抑制P-糖蛋白（p-glycoprotein，P-gp）的表达对难治性癫痫的治疗作用。方法用氯化锂-匹鲁卡品制作慢性颞叶癫痫模型，采用免疫组化法检测P-gp的表达水平；给予P-gp抑制剂维拉帕米，观察其对P-gp的抑制作用及大鼠癫痫发作的影响。结果难治性癫痫组P-gp表达水平较对照组明显增高，P-gp抑制剂维拉帕米可显著降低P-gp的表达水平，大鼠癫痫发作次数明显减少。结论 P-gp过度表达在难治性癫痫耐药性的产生中起重要作用。     

Consideration of epilepsy surgery in adults should be independent of age

Objectives

Epilepsy surgery is performed less frequently in persons over 45 years of age than in younger individuals, probably reflecting biases among patients, referring physicians and neurologists.

Methods

We report on a clinically heterogenous cohort of patients aged 45 years or older who underwent epilepsy surgery for medically intractable epilepsy.

Results

Over a 15-year period, 42 patients with a mean duration of epilepsy of 27.3 years underwent elective surgery. The mean follow-up period was 48 months. Thirty-two patients had an Engel class I outcome, of which 23 were totally seizure-free (Ia). Six patients had a class II outcome (rare disabling seizures), one had a class III outcome (worthwhile improvement), and three had a class IV outcome (no worthwhile improvement). The majority of patients reported an improved quality of life and satisfaction with the epilepsy surgery. A subjective improvement in cognition was reported in 7 patients while a decline was reported in 10 patients. New neuropsychiatric difficulties were reported in three patients while three patients reported improved anxiety after surgery. Only one patient became newly employed after surgery while 23 returned to driving. Permanent complications occurred in four patients (thalamic infarct during a Wada test (n = 1) and asymptomatic visual field defect (n = 3)).

Conclusions

We report a favorable outcome from epilepsy surgery in a large series of older adults and conclude that age per se is not a contraindication to epilepsy surgery. We emphasize the lack of correlation between outcome from surgery and pre-operative duration of epilepsy.     

A survey of adult and pediatric epilepsy surgery in the United Kingdom

All consultant epilepsy neurosurgeons were asked to prospectively record all epilepsy surgery procedures carried out at their center between April 2010 and March 2011. Figures were compared to a previous survey completed in 2000. Of a total of 710 procedures, temporal lobe surgery was the most common resective surgery. Although extratemporal lesional surgery was less common, vagus nerve stimulator (VNS) implantation accounted for almost half the procedures. The numbers for all surgical procedures, with the exception of VNS implantations, had decreased. This decrease may represent a global rather than a regional phenomenon. Further longitudinal multinational data on epilepsy surgery is required to confirm or refute this theory.     

难治性癫痫的MRI改变探讨

目的 探讨磁共振成像(MRI)对难治性癫痫患者病因诊断的价值及其对治疗的指导作用。方法 分析212例难治性癫痫患者的临床和MRI资料。结果 (1)212例难治性癫痫患者中，118例MRI有改变，异常发现阳性率为55．7％(118／212)，揭示的病因共7种，其中以脑软化、脑发育异常多见；(2)不同发作类型的MRI改变阳性率不同；(3)不同发作类型的MRI改变所揭示的病因不同；(4)不同年龄组难治性癫痫患者MRI改变所揭示的病因不同。结论 头颅MRI扫描对难治性癫痫的病因诊断有重要意义，可为难治性癫痫确定治疗方向和选择治疗方法提供可靠依据，对判断难治性癫痫的预后有一定的指导意义。     

Factors predictive of the outcome of frontal lobe epilepsy surgery

PURPOSE: To identify factors that predict the outcome in seizure control after frontal lobe epilepsy surgery (FLES). FLES is the second most frequent type of epilepsy surgery, but the results are generally not as good as those after anterior temporal lobectomy. METHODS: Our cohort consisted of 68 consecutive patients whose first epilepsy surgery involving the frontal lobe occurred between 1987 and 1994. Clinical history and results of imaging and electroencephalographic studies were reviewed in detail. Excellent outcome was defined as being seizure free or having only nondisabling seizures at last follow up. RESULTS: Forty of the 68 patients (58.8%) had an excellent outcome; none of the patients with a history of childhood febrile seizures had an excellent outcome, whereas outcome was excellent in 63% of those without that history (p 相似文献