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成人癫痫的手术治疗

Author
Gregory D Cascino, MD
Section Editor
Timothy A Pedley, MD
Deputy Editor
April F Eichler, MD, MPH
Translators
周列民, 主任医师，教授

引言

癫痫是最常见的慢性神经系统疾病之一，20%-30%的癫痫患者有导致躯体及社会功能丧失的癫痫发作性疾病。这类患者的严重并发症发生率和死亡率增加，包括认知功能障碍、抑郁、躯体创伤和癫痫猝死。对于耐药性癫痫患者，治疗目标是消除癫痫发作，避免治疗相关不良反应，并使患者能够参与社会活动并为社会贡献自己的一份力量。

大多数应用抗癫痫药物(antiepileptic drug, AED)反应良好的个体能够在初始治疗头2年内得到成功治疗。经2种AED适当治疗反应不佳的患者可能有耐药性癫痫，这类患者应该考虑进行手术和其他替代治疗。

对于耐药性局灶性癫痫患者，手术治疗是一种尚未被充分应用的重要治疗方式。癫痫的手术操作从致癫痫皮质的局部切除术(前内侧颞叶和其他局部皮质切除术)，到切除或离断广泛病变的大脑半球皮质的干预措施(功能性大脑半球切除术、胼胝体前部切开术、多处软脑膜下横切术)。后者最常用于儿童癫痫患者，此处不作进一步讨论。总之，只有完全切除致癫痫脑区才有机会长期避免癫痫发作。

本专题将讨论局灶性皮质切除术治疗成人耐药性部分性癫痫。儿童癫痫手术及成人癫痫管理和治疗的其他方面内容将单独讨论。 (参见“儿童癫痫发作和癫痫：初始治疗和监测”和“成人癫痫处理概述”和“耐药性癫痫的评估和治疗”)

手术指征

如果耐药性部分性癫痫患者的癫痫发作起源于可切除的区域，并且手术导致致残性神经系统障碍和认知功能障碍的风险极小，则可考虑采用局部皮质切除术。

                              

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Literature review current through: 2017-07 . | This topic last updated: 2017-05-12.
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