难治性癫痫的外科治疗进展

陈天懿, 赖伊杰, 张小小, 刘伟, 曹春燕, 孙伯民, 占世坤

PDF(572 KB)
PDF(572 KB)
重庆医科大学学报 ›› 2024, Vol. 49 ›› Issue (05) : 570-576. DOI: 10.13406/j.cnki.cyxb.003497
神经系统发作性疾病与癫痫的治疗

难治性癫痫的外科治疗进展

作者信息 +

Advances in surgical treatment of refractory epilepsy

Author information +
History +

摘要

在癫痫患者中,药物难治性癫痫一直占据相当比例。这部分患者在经过精确的评估后或可通过外科治疗的手段达到发作缓解。本文阐述了难治性癫痫的术前神经电生理和影像评估方法,并结合最新临床研究进展,针对不同类型癫痫总结手术治疗方案,补充阐述了无创治疗方法,且在此基础上探讨了癫痫外科治疗未来发展趋势。

Abstract

Medically refractory epilepsy has always affected a considerable proportion of patients with epilepsy. This group of patients may be able to achieve seizure remission by means of surgical treatment after precise evaluation. This article presents preoperative neurophysiological and imaging evaluation methods for refractory epilepsy,and summarizes surgical options for different types of epilepsy in the light of new clinical research advances. We also have a discussion on non-invasive treatments as well as related future trend in surgical treatment for epilepsy.

关键词

难治性癫痫 / 神经诊断技术 / 神经外科手术

Key words

refractory epilepsy / neurological diagnostic technique / neurosurgical procedure

中图分类号

R742.1

引用本文

导出引用
陈天懿 , 赖伊杰 , 张小小 , . 难治性癫痫的外科治疗进展. 重庆医科大学学报. 2024, 49(05): 570-576 https://doi.org/10.13406/j.cnki.cyxb.003497
Chen Tianyi, Lai Yijie, Zhang Xiaoxiao, et al. Advances in surgical treatment of refractory epilepsy[J]. Journal of Chongqing Medical University. 2024, 49(05): 570-576 https://doi.org/10.13406/j.cnki.cyxb.003497

参考文献

1
Anonymous. Epilepsy:a public health imperative[EB/OL] [2023-12-13].
2
孙纪涛,王 斌,李佳音,等. 长程视频脑电图在诊断癫痫中的应用价值研究[J]. 临床医药文献电子杂志20185(99):139,142.
Sun JT Wang B Li JY,et al. Application value of long-range video-EEG in diagnosis of epilepsy[J]. J Clin Med Lit20185(99):139,142.
3
陈 洋. 长程视频脑电图在癫痫及其鉴别诊断中的临床应用分析[D]. 苏州:苏州大学,2017
Chen Y. Clinical application of long-range VEEG in epilepsy and its differential diagnosis[D]. Suzhou:Soochow University,2017
4
肖 岩,韦文科. 诱发试验在癫痫诊断及鉴别诊断中的价值[J]. 华夏医学200720(3):621-623.
Xiao Y Wei WK. The value of evoked test in the diagnosis and differential diagnosis of epilepsy[J]. Acta Med Sin200720(3):621-623.
5
遇 涛. 正确认识脑磁图在癫痫外科中的应用价值[J]. 癫痫与神经电生理学杂志202332(2):65-69.
Yu T. Correct understanding of the application value of magnetoencephalography in epilepsy surgery[J]. J Epileptol Electroneurophysiology China202332(2):65-69.
6
田小霖,王 静,王雄飞,等. 癫痫术前评估中相关脑成像技术的应用及研究进展[J]. 癫痫与神经电生理学杂志202332(2):113-116,125.
Tian XL Wang J Wang XF,et al. Application and research progress of related brain imaging techniques in preoperative evaluation of epilepsy[J]. J Epileptol Electroneurophysiology China202332(2):113-116,125.
7
Winston GP Micallef C Kendell BE,et al. The value of repeat neuroimaging for epilepsy at a tertiary referral centre:16 years of experience[J]. Epilepsy Res2013105(3):349-355.
8
von Oertzen J Urbach H Jungbluth S,et al. Standard magnetic resonance imaging is inadequate for patients with refractory focal epilepsy[J]. J Neurol Neurosurg Psychiatry200273(6):643-647.
9
中国抗癫痫协会立体定向脑电图与脑定位学专业委员会,中国医师协会神经外科医师分会,国家神经外科机器人示范项目专家指导委员会. 立体定向脑电图临床应用的中国专家共识[J]. 中华医学杂志2022102(39):3095-3102.
Professional Committee of Stereotactic Electroencephalography and Brain Localization,Chinese Association Against Epilepsy,Chinese Congress of Neurological Surgeons,National Neurosurgical Robotics Demonstration Program Expert Steering Committee. Chinese expert consensus on the clinical application of stereotactic electroencephalography[J]. Natl Med J China2022102(39):3095–3102.
10
Rugg-Gunn F Miserocchi A McEvoy A. Epilepsy surgery[J]. Pract Neurol202020(1):4-14.
11
中国抗癫痫协会,中华医学会神经外科学分会神经生理学组,中华医学会神经病学分会癫痫与脑电图学组,等. 癫痫外科术前评估中国专家共识(2022版)[J]. 中华神经外科杂志202238(10):973–979.
Chinese Association Against Epilepsy,Neurophysiology Group of the Neurosurgery Section of Chinese Medical Association,Epilepsy and Electroencephalography Group of the Neurology Section of Chinese Medical Association,et al. Chinese expert consensus on preoperative evaluation of epilepsy surgery(2022 edition)[J]. Chin J Neurosurg202238(10):973–979.
12
Scheffer IE Berkovic S Capovilla G,et al. ILAE classification of the epilepsies:position paper of the ILAE Commission for Classification and Terminology[J]. Epilepsia201758(4):512-521.
13
张洋铭,魏怡名,唐振刚. 难治性癫痫的外科诊疗进展[J]. 神经损伤与功能重建202318(6):346-348,372.
Zhang YM Wei YM Tang ZG. Progress in surgical diagnosis and treatment of drug-resistant epilepsy[J]. Neural Inj Funct Reconstr202318(6):346-348,372.
14
Yao K Mei X Liu XZ,et al. Clinical characteristics,pathological features and surgical outcomes of focal cortical dysplasia(FCD) type Ⅱ:correlation with pathological subtypes[J]. Neurol Sci201435(10):1519-1526.
15
Tassi L Garbelli R Colombo N,et al. Electroclinical,MRI and surgical outcomes in 100 epileptic patients with typeⅡFCD[J]. Epileptic Disord201214(3):257-266.
16
徐冰茹,李峥辉,姚 一,等. 药物难治性半球病变性癫痫手术治疗效果及手术方式比较的回顾性研究[J]. 国际神经病学神经外科学杂志201744(2):145-150.
Xu BR Li ZH Yao Y,et al. Surgical outcome of medically intractable hemispheric epilepsy and clinical effect of functional hemispherectomy versus hemispherotomy:a retrospective analysis[J]. J Int Neurol Neurosurg201744(2):145-150.
17
de Palma L Pietrafusa N Gozzo F,et al. Outcome after hemispherotomy in patients with intractable epilepsy:comparison of techniques in the Italian experience[J]. Epilepsy Behav201993:22-28.
18
Pinto AL Lohani S Bergin AM,et al. Surgery for intractable epilepsy due to unilateral brain disease:a retrospective study comparing hemispherectomy techniques[J]. Pediatr Neurol201451(3):336-343.
19
Bourdillon P Devaux B Job-Chapron AS,et al. SEEG-guided radiofrequency thermocoagulation[J]. Clin Neurophysiol201848(1):59-64.
20
中国医师协会神经外科分会功能神经外科学组,中国抗癫痫 协会,国家神经外科手术机器人应用示范项目专家指导委员会. 立体定向脑电图引导射频热凝毁损治疗药物难治性癫痫的中国专家共识[J]. 中华医学杂志2021101(29):2276-2282.
Functional Neurosurgery Group of Chinese Congress of Neurological Surgeons,Chinese Association Against Epilepsy,National Neurosurgical Robotics Demonstration Program Expert Steering Committee. China expert consensus on stereotactic EEG-guided radiofrequency thermocoagulation in the treatment of drug-refractory epilepsy[J]. Natl Med J China2021101(29):2276-2282.
21
Bourdillon P Isnard J Catenoix H,et al. Stereo electroence-phalography-guided radiofrequency thermocoagulation(SEEG-guided RF-TC) in drug-resistant focal epilepsy:results from a 10-year experience[J]. Epilepsia201758(1):85-93.
22
van Gompel JJ Burkholder DB Parker JJ,et al. Laser interstitial thermal therapy for epilepsy[J]. Neurosurg Clin N Am202334(2):247-257.
23
McCracken DJ Willie JT Fernald BA,et al. Magnetic resonance thermometry-guided stereotactic laser ablation of cavernous malformations in drug-resistant epilepsy:imaging and clinical results[J]. Oper Neurosurg201612(1):39-48.
24
Drane DL. MRI-Guided stereotactic laser ablation for epilepsy surgery:promising preliminary results for cognitive outcome[J]. Epilepsy Res2018142:170-175.
25
Asadi-Pooya A Brigo F Lattanzi S,et al. Adult epilepsy[J]. Lancet2023402:412-424.
26
Ryvlin P Rheims S Hirsch LJ,et al. Neuromodulation in epilepsy:state-of-the-art approved therapies[J]. Lancet Neurol202120(12):1038-1047.
27
Roosevelt RW Smith DC Clough RW,et al. Increased extracellular concentrations of norepinephrine in cortex and hippocampus following vagus nerve stimulation in the rat[J]. Brain Res20061119(1):124-132.
28
Ben-Menachem E. Vagus-nerve stimulation for the treatment of epilepsy[J]. Lancet Neurol20021(8):477-482.
29
Englot DJ Rolston JD Wright CW,et al. Rates and predictors of seizure freedom with vagus nerve stimulation for intractable epilepsy[J]. Neurosurgery201679(3):345-353.
30
Jain P Arya R. Vagus nerve stimulation and seizure outcomes in pediatric refractory epilepsy:systematic review and meta-analysis[J]. Neurology202196(22):1041-1051.
31
Gouveia FV Warsi NM Suresh H,et al. Neurostimulation treatments for epilepsy:deep brain stimulation,responsive neurostimulation and vagus nerve stimulation[J]. Neurotherapeutics202421(3):e00308.
32
Eggleston KS Olin BD Fisher RS. Ictal tachycardia:the head-heart connection[J]. Seizure201423(7):496-505.
33
Kawaji H Yamamoto T Fujimoto A,et al. Additional seizure reduction by replacement with Vagus Nerve Stimulation Model 106 (AspireSR)[J]. Neurosci Lett2020716:134636.
34
Lo WB Chevill B Philip S,et al. Seizure improvement following vagus nerve stimulator (VNS) battery change with cardiac-based seizure detection automatic stimulation (AutoStim):early experience in a regional paediatric unit[J]. Childs Nerv Syst202137(4):1237-1241.
35
Warsi NM Yan H Suresh H,et al. The anterior and centromedian thalamus:anatomy,function,and dysfunction in epilepsy[J]. Epilepsy Res2022182:106913.
36
Salanova V Witt T Worth R,et al. Long-term efficacy and safety of thalamic stimulation for drug-resistant partial epilepsy[J]. Neurology201584(10):1017-1025.
37
Bouwens van der Vlis TAM, Schijns OEMG FLWVJ Schaper,et al. Deep brain stimulation of the anterior nucleus of the thalamus for drug-resistant epilepsy[J]. Neurosurg Rev201942(2):287-296.
38
Wong S Mani R Danish S. Comparison and selection of current implantable anti-epileptic devices[J]. Neurotherapeutics201916(2):369-380.
39
Morrell MJ,System in Epilepsy Study Group RNS. Responsive cortical stimulation for the treatment of medically intractable partial epilepsy[J]. Neurology201177(13):1295-1304.
40
Seneviratne U Cook M D’Souza W. The prognosis of idiopathic generalized epilepsy[J]. Epilepsia201253(12):2079-2090.
41
Bullinger KL Alwaki A Gross RE. Surgical treatment of drug-resistant generalized epilepsy[J]. Curr Neurol Neurosci Rep202222(8):459-465.
Bullinger KL Alwaki A Gross RE. Surgical treatment of drug-resistant generalized epilepsy[J]. Curr Neurol Neurosci Rep202222(8):459-465.
42
Chan AY Rolston JD Lee B,et al. Rates and predictors of seizure outcome after corpus callosotomy for drug-resistant epilepsy:a meta-analysis[J]. J Neurosurg2018130(4):1193-1202.
Chan AY Rolston JD Lee B,et al. Rates and predictors of seizure outcome after corpus callosotomy for drug-resistant epilepsy:a meta-analysis[J]. J Neurosurg2018130(4):1193-1202.
43
Asadi-Pooya AA Sharan A Nei M,et al. Corpus callosotomy[J]. Epilepsy & Behavior200813(2):271–278.
44
Roland JL SHA Akbari Salehi A,et al. Corpus callosotomy performed with laser interstitial thermal therapy[J]. J Neurosurg2019134(1):314-322.
45
Filipescu C Lagarde S Lambert I,et al. The effect of medial pulvinar stimulation on temporal lobe seizures[J]. Epilepsia201960(4):e25-e30.
46
Vesper J Steinhoff B Rona S,et al. Chronic high-frequency deep brain stimulation of the STN/SNr for progressive myoclonic epilepsy[J]. Epilepsia200748(10):1984-1989.
47
Hallett M. Transcranial magnetic stimulation and the human brain[J]. Nature2000406(6792):147-150.
48
Iglesias AH. Transcranial magnetic stimulation as treatment in multiple neurologic conditions[J]. Curr Neurol Neurosci Rep202020(1):1.
49
Hsu WY Cheng CH Lin MW,et al. Antiepileptic effects of low frequency repetitive transcranial magnetic stimulation:a meta-analysis[J]. Epilepsy Res201196(3):231-240.
50
Wang Z Zhang XY Meiduo GS,et al. Time-effectiveness of low-frequency rTMS for epilepsy and improvement in cognitive function in patients:a systematic review and meta-analysis[J]. Epilepsy Res2024199:107277.
51
Monteith S Snell J Eames M,et al. Transcranial magnetic resonance-guided focused ultrasound for temporal lobe epilepsy:a laboratory feasibility study[J]. J Neurosurg2016125(6):1557-1564.
52
Abe K Yamaguchi T Hori H,et al. Magnetic resonance-guided focused ultrasound for mesial temporal lobe epilepsy:a case report[J]. BMC Neurol202020(1):160.
53
Yamaguchi T Hori T Hori H,et al. Magnetic resonance-guided focused ultrasound ablation of hypothalamic hamartoma as a disconnection surgery:a case report[J]. Acta Neurochir2020162(10):2513-2517.
54
Maliia MD Nica A Baxter J,et al. Focused ultrasounds:what is their future in epileptology?A critical review[J]. Rev Neurol2023:S0035-S3787(23)01145-1.
55
王俊华,孟凡刚,刘阿力. 伽玛刀治疗颞叶癫痫的研究进展[J]. 中华神经外科杂志201329(1):103-106.
Wang JH Meng FG Liu AL. Research progress of gamma knife in the treatment of temporal lobe epilepsy[J]. Chin J Neurosurg201329(1):103-106.
56
Barbaro NM Quigg M Broshek DK,et al. A multicenter,prospective pilot study of gamma knife radiosurgery for mesial temporal lobe epilepsy:seizure response,adverse events,and verbal memory[J]. Ann Neurol200965(2):167-175.
57
Galan FN Beier AD Sheth RD. Advances in epilepsy surgery[J]. Pediatr Neurol2021122:89-97.
58
West S Nevitt SJ Cotton J,et al. Surgery for epilepsy[J]. Cochrane Database Syst Rev20196(6):CD010541.
59
Prus N Grant AC. Patient beliefs about epilepsy and brain surgery in a multicultural urban population[J]. Epilepsy Behav201017(1):46-49.
60
Lamberink HJ Otte WM Blümcke I,et al. Seizure outcome and use of antiepileptic drugs after epilepsy surgery according to histopathological diagnosis:a retrospective multicentre cohort study[J]. Lancet Neurol202019(9):748-757.
61
Perry MS Donahue DJ Malik SI,et al. Magnetic resonance imaging-guided laser interstitial thermal therapy as treatment for intractable insular epilepsy in children[J]. J Neurosurg Pediatr201720(6):575-582.
62
Gupta K Cabaniss B Kheder A,et al. Stereotactic MRI-guided laser interstitial thermal therapy for extratemporal lobe epilepsy[J]. Epilepsia202061(8):1723-1734.
63
Gireesh ED Lee K Skinner H,et al. Intracranial EEG and laser interstitial thermal therapy in MRI-negative insular and/or cingulate epilepsy:case series[J]. J Neurosurg2020135(3):751-759.
64
Graham D Tisdall MM Gill D. Corpus callosotomy outcomes in pediatric patients:Asystematic review[J]. Epilepsia201657(7):1053-1068.
65
Suller Marti A Mirsattari SM MacDougall K,et al. Vagus nerve stimulation in patients with therapy-resistant generalized epilepsy[J]. Epilepsy Behav2020111:107253.
66
Cukiert A Cukiert CM Burattini JA,et al. Seizure outcome during bilateral,continuous,thalamic centromedian nuclei deep brain stimulation in patients with generalized epilepsy:a prospective,open-label study[J]. Seizure202081:304-309.
67
Alcala-Zermeno JL Gregg NM Wirrell EC,et al. Centromedian thalamic nucleus with or without anterior thalamic nucleus deep brain stimulation for epilepsy in children and adults:a retrospective case series[J]. Seizure202184:101-107.
68
McGonigal A Sahgal A De Salles A,et al. Radiosurgery for epilepsy:systematic review and International Stereotactic Radiosurgery Society (ISRS) practice guideline[J]. Epilepsy Res2017137:123-131.
69
Feng ES Sui CB Wang TX,et al. Stereotactic radiosurgery for the treatment of mesial temporal lobe epilepsy[J]. Acta Neurol Scand2016134(6):442-451.
70
De Palma L De Benedictis A Specchio N,et al. Epileptogenic network formation[J]. Neurosurg Clin N Am202031(3):335-344.
71
De Benedictis A De Palma L Rossi-Espagnet MC,et al. Connectome-based approaches in pediatric epilepsy surgery:“state-of-the art” and future perspectives[J]. Epilepsy Behav2023149:109523.

基金

国家重点研发计划资助项目(2022YFB4702705)
国家自然科学基金资助项目(82101546)

评论

PDF(572 KB)

Accesses

Citation

Detail

段落导航
相关文章

/