药物难治性癫痫外科干预的时机及策略  

Timing and statregy of surgery intervention for drug resistant epilepsy

作　　者：王薇薇[1] 吴逊[1] WANG Weiwei;WU Xun(Department of Neurology,First Hospital of Peking University,Beijing 100034,China)

机构地区：[1]北京大学第一医院神经内科,北京100034

出　　处：《癫痫杂志》2025年第2期127-135,共9页Journal of Epilepsy

摘　　要：药物难治性癫痫(drug-resistant epilepsy,DRE)不仅有发作对患者造成的损伤,还会影响患者的生活质量、认知功能及社会交往,在儿童更可使发育迟滞甚至倒退。目前公认对于有限局性病变的DRE外科为有效的治疗,术后60%患者5年无发作。目前外科干预的标准仍是达到DRE诊断标准后早期治疗,但时常需要等待较长时间。近年由于检测方法及外科技术的进展,对诊断、定位明确的有限局结构异常的患者可以在有条件的癫痫中心,慎重多学科讨论后在未形成DRE前外科治疗。尤其是在儿童。因3岁以前儿童大脑可塑性强,可以修复受损的认知功能,特别是语言功能,改善生活质量。但目前外科干预时常延迟。其原因包括:(1)诊断延迟;(2)患者及亲属认为外科治疗有风险;(3)一般医生认为外科干预是最后的选择;(4)患者特殊情况如:年龄、有共病、症状和脑电图及影像学三者定位有分歧等。Drug-resistant epilepsy(DRE)not only have disruption of the patients by seizure,but also influence the quality of life,cognitive function and social association,as well as development delay even retrogression for children.Epilepsy surgery is the only curative treatment currently available for focal lesional pharmacoresistant epilepsy,five years complete seizure freedom rates was around 60%after surgery.The criterion of surgical intervention at present is achievement for the diagnosis of DRE,thereafter consideration of early epilepsy surgery,but these maybe a long-term duration.Recent advance in examine methods and surgical techniques have improved the surgical treatment of epilepsy,to such patient with focal lesional structure abnormality,before the DRE emergence,under the discussion of the multidisciplinary team.Children under 3 years old,the brain have greater neural plasticity,early surgical treatment is expected at llow the healthy brain to recover and develop the language function and quality of life.Numerous cause may pose abstracts to the delay of surgical intervention:(1)diagnosis delay;(2)patient himself and their familiar recognize that there have same risk of surgical treatment;(3)the primary doctor firmly believe that epilepsy surgery is the ultimate methods;(4)special problems of the patient,such including:age,comorbidity,and the location of symptom,EEG as well as imaging non-conformation.

关 键 词：药物难治性癫痫 抗癫痫发作药物 外科干预 伴知觉障碍的部分性发作 有限局性结构异常的局灶性发作 

分 类 号：R74[医药卫生—神经病学与精神病学]