Lennox-Gastaut综合征患者的手术选择_Journal of Epilepsy

Authors：

 DouglassLM , SalpekarJ , 蒋忱希 , 杨小枫

Corresponding author：

DouglassLM, Email: lauric.douglass@bmc.org

Keywords：

癫痫; 儿童; 胼胝体切开术; 切除性手术

DOI：

10.7507/2096-0247.20160065

Video：

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尽管目前关于Lennox-Gastaut综合征（LGS）患者药物治疗的研究越来越多，但药物治疗的效果研究仍然不令人满意。在许多情况下，LGS仍然是难治性的且导致包括智力低下，持续性癫痫发作和一些精神疾病等不良预后。对其他治疗方式无效的LGS患者进一步的选择是手术治疗。术前评估应包括发作间期脑电图（EEG）、磁共振成像（MRI）分析和年龄相关的神经/发育评估。手术切除癫痫灶可以在很多患者成功的控制癫痫发作，尤其是病灶切除术或者脑叶切除术效果较好。最近的有关报道肯定了LGS患者手术切除的效果，大部分患者的癫痫发作得到有效的控制。胼胝体切开术是一种姑息性的手术方式，其目的是通过防止癫痫活动向双侧半球扩散来控制潜在的损伤性发作。例如，对于失张力或跌倒性发作，它具有高发病率和高死亡率，显微外科手术限制于胼胝体前部，大大降低了胼胝体切开术的手术并发症。迷走神经刺激是另一种姑息治疗方式，迷走神经刺激的疗效与胼胝体切开术类似，但在失张力发作中，胼胝体切开术疗效更好。外科手术技术的最新进展为LGS患者提供了更多有效的治疗选择。

Citation： DouglassLM, SalpekarJ, 蒋忱希, 杨小枫. Lennox-Gastaut综合征患者的手术选择. Journal of Epilepsy, 2016, 2(4): 366-372. doi: 10.7507/2096-0247.20160065 Copy

1.	Camfield PR.Definition and natural history of Lennox-Gastaut syndrome.Epilepsia, 2011, 52(Suppl 5):3-9.
2.	Arzimanoglou A, French J, Blume WT, et al.Lennox-Gastaut syndrome:a consensus approach on diagnosis, assessment, management, and trial methodology.Lancet Neurol, 2009, 8(1):82-93.
3.	Riikonen R.Long-term outcome of patients with West syndrome.Brain Dev, 2001, 23(5):683-687.
4.	Wyllie E, Lachhwani DK, Gupta A, et al.Successful surgery for epilepsy due to early brain lesions despite generalized EEG findings.Neurology, 2007, 69(2):389-397.
5.	Markand ON.Slow spike-wave activity in EEG and associated clinical features:often called 'Lennox' or 'Lennox-Gastaut' syndrome.Neurology, 1977, 27(8):746-757.
6.	Markand ON.Lennox-Gastaut syndrome (childhood epileptic encephalopathy).J Clin Neurophysiol, 2003, 20(11):426-441.
7.	Kwan P, Arzimanoglou A, Berg AT, et al.Definition of drug resistant epilepsy:consensus proposal by the ad hoc Task Force of the ILAE Commission on Therapeutic Strategies.Epilepsia, 2010, 51(10):1069-1077.
8.	Jadhav T, Cross JH.Surgical approaches to treating epilepsy in children.Curr Treat Options Neurol, 2012, 14(8):620-629.
9.	Shorvon S.Handbook of epilepsy treatment.2nd Ed.Boston, MA:Blackwell Publishing, 2005.
10.	Cross JH, Jayakar P, Nordli D, et al.Proposed criteria for referral and evaluation of children for epilepsy surgery:recommendations of the subcommission for pediatric epilepsy surgery.Epilepsia, 2006, 47(8):952-959.
11.	Liu SY, An N, Fang X, et al.Surgical treatment of patients with Lennox-Gastaut syndrome phenotype.Scientific World Journal, 2012, 12(2):614263.
12.	Sueda K, Takeuchi F, Shiraishi H, et al.Magnetoencephalographic analysis of paroxysmal fast activity in patients with epileptic spasms.Epilepsy Res, 2013, 104(3):68-77.
13.	Bauer PR, Reitsma JB, Houweling BM, et al.Can fMRI safely replace the Wada test for preoperative assessment of language lateralization:a meta-analysis and systematic review.J Neurol Neurosurg Psychiatry, 2014, 85(20):581-588.
14.	Wong TT, Kwan SY, Chang KP, et al.Corpus callosotomy in children.Childs Nerv Syst, 2006, 22(5):999-1011.
15.	Engel J Jr, Van Ness PC, Rasmussen TB, et al.Outcome with respect to epileptic seizures.In Engel J Jr (Ed) Surgical treatment of the epilepsies.New York:Raven Press, 1993:609-621.
16.	Lee YJ, Kang HC, Lee JS, et al.Resective pediatric epilepsy surgery in Lennox-Gastaut syndrome.Pediatrics, 2010, 125(Suppl 1):58-66.
17.	Mathews MS, Linskey ME, Binder DK, et al.van Wagenen and the first corpus callosotomies for epilepsy.J Neurosurg, 2008, 108(1):608-613.
18.	Purves SJ, Wada JA, Woodhurst WB, et al.Results of anterior corpus callosum section in 24 patients with medically intractable seizures.Neurology, 1988, 38(3):1194-1201.
19.	van Rijckevorsel K.Treatment of Lennox-Gastaut syndrome:overview and recent findings.Neuropsychiatr Dis Treat, 2008, 4(1):1001-1019.
20.	Cukiert A, Burattini JA, Mariani PP, et al.Extended, one-stage callosal section for treatment of refractory secondarily generalized epilepsy in patients with Lennox-Gastaut and Lennox-like syndromes.Epilepsia, 2006, 47(11):371-374.
21.	Feichtinger M, Schrottner O, Eder H, et al.Efficacy and safety of radio surgical callosotomy:a retrospective analysis.Epilepsia, 2006, 47(10):1184-1191.
22.	Georgia Regents University.Surgical Management of Epilepsy Image Gallery.Available at:http://www.gru.edu/mcg/neurosurgery/clinicalprograms/esphoto_gallery.php.AccessedMarch, 27, 2014.
23.	Rossi GF, Colicchio G, Marchese E, et al.Callosotomy for severe epilepsies with generalized seizures:outcome and prognostic factors.Acta Neurochir, 1996, 138(11):221-227.
24.	Yang TF, Wong TT, Kwan SY, et al.Quality of life and life satisfaction in families after a child has undergone corpus callostomy.Epilepsia, 1996, 37(9):76-80.
25.	Lin JH, Kwan SY.Post-section recruitment of epileptiform discharges in electrocorticography during callosotomy in 48 patients with Lennox-Gastaut syndrome.J Clin Neurosci, 2012, 19(8):388-393.
26.	Kwan SY, Wong TT, Chang KP, et al.Seizure outcome after corpus callosotomy:the taiwan experience.Childs Nerv Syst, 2000, 16(2):87-92.
27.	Hur YJ, Kang HC, Kim DS, et al.Uncovered primary seizure foci in Lennox-Gastaut syndrome after corpus callosotomy.Brain Dev, 2011, 33(6):672-677.
28.	Ferrie CD, Patel A.Treatment of Lennox-Gastaut syndrome (LGS).Eur J Paediatr Neurol, 2009, 13(8):493-504.
29.	Frost M, Gates J, Helmers SL, et al.Vagus nerve stimulation in children with refractory seizures associated with Lennox-Gastaut syndrome.Epilepsia, 2001, 42(2):1148-1152.
30.	You SJ, Kang HC, Ko TS, et al.Comparison of corpus callosotomy and vagus nerve stimulation in children with Lennox-Gastaut syndrome.Brain Dev, 2008, 30(5):195-199.
31.	Lancman G, Virk M, Shao H, et al.Vagus nerve stimulation vs.corpus callosotomy in the treatment of Lennox-Gastaut syndrome:a metaanalysis.Seizure, 2013, 22(8):3-8.
32.	Trevathan E.Infantile spasms and Lennox-Gastaut syndrome.J Child Neurol, 2002, 17(Suppl 2):9-22.
33.	Karceski S.Vagus nerve stimulation and Lennox-Gastaut syndrome:a review of the literature and data from the VNS patient registry.CNS Spectr, 2001, 6(1):766-770.

1. Camfield PR.Definition and natural history of Lennox-Gastaut syndrome.Epilepsia, 2011, 52(Suppl 5):3-9.
2. Arzimanoglou A, French J, Blume WT, et al.Lennox-Gastaut syndrome:a consensus approach on diagnosis, assessment, management, and trial methodology.Lancet Neurol, 2009, 8(1):82-93.
3. Riikonen R.Long-term outcome of patients with West syndrome.Brain Dev, 2001, 23(5):683-687.
4. Wyllie E, Lachhwani DK, Gupta A, et al.Successful surgery for epilepsy due to early brain lesions despite generalized EEG findings.Neurology, 2007, 69(2):389-397.
5. Markand ON.Slow spike-wave activity in EEG and associated clinical features:often called 'Lennox' or 'Lennox-Gastaut' syndrome.Neurology, 1977, 27(8):746-757.
6. Markand ON.Lennox-Gastaut syndrome (childhood epileptic encephalopathy).J Clin Neurophysiol, 2003, 20(11):426-441.
7. Kwan P, Arzimanoglou A, Berg AT, et al.Definition of drug resistant epilepsy:consensus proposal by the ad hoc Task Force of the ILAE Commission on Therapeutic Strategies.Epilepsia, 2010, 51(10):1069-1077.
8. Jadhav T, Cross JH.Surgical approaches to treating epilepsy in children.Curr Treat Options Neurol, 2012, 14(8):620-629.
9. Shorvon S.Handbook of epilepsy treatment.2nd Ed.Boston, MA:Blackwell Publishing, 2005.
10. Cross JH, Jayakar P, Nordli D, et al.Proposed criteria for referral and evaluation of children for epilepsy surgery:recommendations of the subcommission for pediatric epilepsy surgery.Epilepsia, 2006, 47(8):952-959.
11. Liu SY, An N, Fang X, et al.Surgical treatment of patients with Lennox-Gastaut syndrome phenotype.Scientific World Journal, 2012, 12(2):614263.
12. Sueda K, Takeuchi F, Shiraishi H, et al.Magnetoencephalographic analysis of paroxysmal fast activity in patients with epileptic spasms.Epilepsy Res, 2013, 104(3):68-77.
13. Bauer PR, Reitsma JB, Houweling BM, et al.Can fMRI safely replace the Wada test for preoperative assessment of language lateralization:a meta-analysis and systematic review.J Neurol Neurosurg Psychiatry, 2014, 85(20):581-588.
14. Wong TT, Kwan SY, Chang KP, et al.Corpus callosotomy in children.Childs Nerv Syst, 2006, 22(5):999-1011.
15. Engel J Jr, Van Ness PC, Rasmussen TB, et al.Outcome with respect to epileptic seizures.In Engel J Jr (Ed) Surgical treatment of the epilepsies.New York:Raven Press, 1993:609-621.
16. Lee YJ, Kang HC, Lee JS, et al.Resective pediatric epilepsy surgery in Lennox-Gastaut syndrome.Pediatrics, 2010, 125(Suppl 1):58-66.
17. Mathews MS, Linskey ME, Binder DK, et al.van Wagenen and the first corpus callosotomies for epilepsy.J Neurosurg, 2008, 108(1):608-613.
18. Purves SJ, Wada JA, Woodhurst WB, et al.Results of anterior corpus callosum section in 24 patients with medically intractable seizures.Neurology, 1988, 38(3):1194-1201.
19. van Rijckevorsel K.Treatment of Lennox-Gastaut syndrome:overview and recent findings.Neuropsychiatr Dis Treat, 2008, 4(1):1001-1019.
20. Cukiert A, Burattini JA, Mariani PP, et al.Extended, one-stage callosal section for treatment of refractory secondarily generalized epilepsy in patients with Lennox-Gastaut and Lennox-like syndromes.Epilepsia, 2006, 47(11):371-374.
21. Feichtinger M, Schrottner O, Eder H, et al.Efficacy and safety of radio surgical callosotomy:a retrospective analysis.Epilepsia, 2006, 47(10):1184-1191.
22. Georgia Regents University.Surgical Management of Epilepsy Image Gallery.Available at:http://www.gru.edu/mcg/neurosurgery/clinicalprograms/esphoto_gallery.php.AccessedMarch, 27, 2014.
23. Rossi GF, Colicchio G, Marchese E, et al.Callosotomy for severe epilepsies with generalized seizures:outcome and prognostic factors.Acta Neurochir, 1996, 138(11):221-227.
24. Yang TF, Wong TT, Kwan SY, et al.Quality of life and life satisfaction in families after a child has undergone corpus callostomy.Epilepsia, 1996, 37(9):76-80.
25. Lin JH, Kwan SY.Post-section recruitment of epileptiform discharges in electrocorticography during callosotomy in 48 patients with Lennox-Gastaut syndrome.J Clin Neurosci, 2012, 19(8):388-393.
26. Kwan SY, Wong TT, Chang KP, et al.Seizure outcome after corpus callosotomy:the taiwan experience.Childs Nerv Syst, 2000, 16(2):87-92.
27. Hur YJ, Kang HC, Kim DS, et al.Uncovered primary seizure foci in Lennox-Gastaut syndrome after corpus callosotomy.Brain Dev, 2011, 33(6):672-677.
28. Ferrie CD, Patel A.Treatment of Lennox-Gastaut syndrome (LGS).Eur J Paediatr Neurol, 2009, 13(8):493-504.
29. Frost M, Gates J, Helmers SL, et al.Vagus nerve stimulation in children with refractory seizures associated with Lennox-Gastaut syndrome.Epilepsia, 2001, 42(2):1148-1152.
30. You SJ, Kang HC, Ko TS, et al.Comparison of corpus callosotomy and vagus nerve stimulation in children with Lennox-Gastaut syndrome.Brain Dev, 2008, 30(5):195-199.
31. Lancman G, Virk M, Shao H, et al.Vagus nerve stimulation vs.corpus callosotomy in the treatment of Lennox-Gastaut syndrome:a metaanalysis.Seizure, 2013, 22(8):3-8.
32. Trevathan E.Infantile spasms and Lennox-Gastaut syndrome.J Child Neurol, 2002, 17(Suppl 2):9-22.
33. Karceski S.Vagus nerve stimulation and Lennox-Gastaut syndrome:a review of the literature and data from the VNS patient registry.CNS Spectr, 2001, 6(1):766-770.

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