癫痫的外科治疗

我国的癫痫的患病率为7‰,患者总数在900万人以上,新抗癫痫药物不断出现使得疗效不断提高,但仍有20%～30%患者的发作用药物难以完全控制,属于难治性癫痫.难治性癫痫患者中有一半可通过手术治愈或再辅以抗癫痫药物而得到控制.我国每年约有25000～30000癫痫病人需要手术,在此对癫痫外科治疗的有关问题作一简单介绍.     

难治性癫痫的外科诊疗进展

癫痫是由各种原因引起的脑神经元高度同步化异常放电所致的临床综合征,其患病率为0.8%~1.2%。30%~40%的癫痫患者呈药物难治性(规律使用一线抗癫痫药物2年仍不能充分控制癫痫发作),其中10%~50%该类患者可以选择癫痫手术治疗。癫痫手术旨在通过切除致痫灶控制癫痫发作,同时通过保留重要的大脑功能区域以避免神经心理和功能出现障碍。本文就难治性癫痫外科手术过程中的术前评估、致痫灶定位、手术方式的选择及手术预后等几个方面综述如下。     

癫痫的外科治疗

癫痫的外科治疗是功能神经外科的重要组成部分,按2000年的流行病学调查结果显示:我国癫痫的终生患病率为0.7‰,活动性癫痫的患病率为4.6‰,推断我国约有900万人患癫痫,其中活动性患者达600万,但20％左右为难治性癫痫,这其中至少有50％的患者适合手术治疗.     

颞叶癫痫的诊断和外科治疗

目的探讨颞叶癫痫的诊断和治疗方法。方法利用EEG和MR对30例颞叶癫痫（TLE）病例的癫痫灶进行定位诊断，依据诊断结果对其中15例实施前颞叶切除术，另15例接受选择性海马杏仁切除术，并分析其近期疗效及随访结果。结果30例病例中手术疗效满意18例；显著11例；良好1例，术后无并发症发生。结论MR有助于对TLE的定位诊断；手术是治疗顽固性TLE的重要手段，对于EEG和MR提示为颞叶内侧癫痫的病例应选用选择性海马杏仁核切除，采用经颧弓颞底入路使手术更为安全。     

重视癫痫的外科治疗

据世界卫生组织估计,全球大约有5千万癫痫患者.国内流行病学资料显示,我国癫痫"终生患病率"在0.4%～0.7%之间,而活动性癫痫约有600万左右,同时每年有40万左右的新发癫痫患者.癫痫发作常给患者造成巨大的生理和心理障碍,严重影响患者的生存质量,给家庭和社会带来沉重的压力.     

蛛网膜囊肿伴癫痫的外科治疗

目的：探讨颅内蛛网膜囊肿(AC)与癫痫的关系以及外科治疗方法。方法：手术治疗AC伴癫痫23例,其中额叶4例,顶叶4例,颞叶13例,枕叶2例;囊肿直径在3cm以下5例,3～6cm15例,6cm以上3例;采用AC 致痫灶切除21例,AC腹腔分流术1例,胼胝体切开术1例。结果：23例病人中,完全不发作有5例,显改善有11例,无变化7例。结论：颅内蛛网膜囊肿(AC)可引起癫痫,采用AC 致痫灶切除效果较为理想。     

难治性癫痫的规范化外科治疗

随着人类医学的发展,80％左右癫痫患者的发作已经能通过现有的内科治疗手段得到长期控制,甚至约半数以上的患者停药后可以终生不再发病,然而,临床上尚有20％～ 30％的患者用目前的治疗方法难以终止其发作,这部分患者所患癫痫被称为难治性癫痫(intractable epilepsy).难治性癫痫在临床上日益受到关注,已成为人类征服癫痫的最大障碍.据统计,我国难治性癫痫患者不少于100万例[1].     

癫痫外科治疗新进展

癫痫外科治疗新进展古金海综述江澄川徐启武审校（上海医科大学华山医院神经外科上海２０００４０）ＰｒｏｇｒｅｓｓｏｎｔｈｅＳｕｒｇｉｃａｌＴｈｅｒａｐｙｏｆＥｐｉｌｅｐｓｙＧｕＪｉｎｈａｉ（ＨｕａｓｈａｎＨｏｓｐｉｔａｌ，ＳｈａｎｇｈａｉＭｅｄｉｃａｌＵ...     

癫痫立体定向放射外科治疗

2．1 癫痫病灶的立体定位诊断癫痫病灶的准确立体定位是放射外科治疗成功的关键与前提条件，癫痫病灶不能简单地等同于形态结构异常，尤其是特发性癫痫，其CT等结构显像常仅能显示脑萎缩、脑软化等非定位性改变，需要更仔细的临床、电生理、功能、生化显像定位进一步确定癫痫病灶。     

癫痫病人外科治疗与预防

我科对药物治疗无效的59例癫痫患者经手术治疗,效果满意。癫痫病人手术前后的护理,我们强调心理护理、密切观察病情变化、防止自伤及他伤、预防并发症、协助患者及时服药的重要性。现就临床护理浅谈一下体会。1临床资料1.1一般资料男45例,女14例。年龄2～54岁,平均年龄22.8岁。     

超声刀辅助下低位直肠癌的手术治疗

目的探索开放超声刀在中、低位直肠癌全直肠系膜切除术中的应用前景。方法按全直肠系膜切除术（TME）原则,应用开放超声刀对32例低位直肠癌患者实施TME保肛或Miles手术,观察患者术中出血、手术时间、术后骶前引流量、术后恢复时间及术后并发症。结果32例手术获成功,手术时间120～220min,平均170min;手术出血50～200ml,平均125ml;骶前引流管引流液均〈30ml,术后2～4d恢复胃肠道功能并下床活动,住院时间8—14d,平均10d。无术中及术后并发症发生。结论超声刀具有精确切割、凝血可控制的功能,损伤小。开放超声刀在低位直肠癌全系膜切除术中的应用,使手术操作简化,时间缩短,术中出血少,术后骶前间隙渗液减少,提高了腹腔手术的安全性,保肛率高,创伤小,术后疼痛轻,恢复快,是一极具应用前景的微创外科新技术。     

Correlates of physical activity in low income college students

The importance of physical activity as a health promoting behavior has been well documented. We examined the relationship of social support, self‐efficacy, and commitment to a plan of physical activity on physical activity behaviors in a sample of low income college students. Those with higher levels of social support, self‐efficacy, and commitment to a plan of physical activity reported more physical activity behaviors. Commitment to a plan of physical activity mediated the relationships of social support and physical activity behavior, and of self‐efficacy and physical activity behavior. The results support the importance of exploring the psychosocial correlates of physical activity in explaining the decision process that underlies physical activity behavior. © 2009 Wiley Periodicals, Inc. Res Nurs Health 32:634–646, 2009     

Perceived reasons for depression among low income women of Mexican descent

From a larger cross-sectional study of 315 women of Mexican descent, this secondary analysis focused on short answers to open-ended questions related to reasons given by 107 women at risk for depression (>16 on CES-D) for feelings of sadness, hopelessness, or depression within the last month. Data were analyzed using grounded theory techniques. Six categories of reasons were derived from data including: (1) partner issues, (2) family issues, (3) feelings of being alone, (4) inability to provide for material needs, (5) bodily symptoms and experiences, and (6) vague nonspecific reasons. Results are useful for designing future treatment programs.     

From next-generation sequencing to targeted treatment of non-acquired epilepsies

Introduction: Within the last decade, next-generation sequencing (NGS) has resulted in remarkable advances in the field of epilepsy genetics. NGS has become a routine part of the diagnostic workup in many countries. A workup that has led to higher diagnostic yields and insights into the underlying disease mechanisms.

Areas covered: In this review, we report on the recent contributions of NGS testing to the diagnosis and the understanding of pathophysiological mechanisms, phenotypic variability, and genetic heterogeneity of different epilepsies including developmental and/or epileptic encephalopathies, focal and generalized epilepsies. Furthermore, we discuss how the increased knowledge of the genetic architecture of the epilepsies can be translated into more personalized treatment.

Expert opinion/commentary: Targeted gene panels or whole exome sequencing can provide a genetic diagnosis for up to 30% of the patients with early-onset epilepsy. Despite current technical limitations, NGS-based technologies can become the new first-tier diagnostic tests in the epilepsies. As the pool of genetically diagnosed patients has increased, so has the demand for more accurate treatment. Approximately 25% of the epilepsy patients with de novo mutations have genetic diagnoses with potential targets for precision medicine approaches, thus illustrating the enormous utility of genetic testing for therapeutic decision-making.