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find Keyword "切除性手术" 2 results
  • Lennox-Gastaut综合征患者的手术选择

    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。

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  • Clinical features and outcomes of resective surgery in children with frontal lobe epilepsy: The experience of children’s epilepsy center

    Objective To investigate clinical features and surgical outcome in children with frontal lobe epilepsy by evaluating the correlation between the predictive factors and seizure freedom. Methods 18 children who underwent frontal lobe epileptogenic resection in the Epilepsy Center of the Children's Hospital of Fudan University between January 2017 and December 2019 with a minimum follow up of 2 year were analyzed retrospectively. Each patient was evaluated with detailed data to predict postsurgical seizure freedom by analysis of variance. Results Of the 18 patients, there were 11 males and 7 females, the age at surgery ranged from 21 months to 11 years old (6.8±2.73) and the duration of seizures was from 1 month to 9 years. 17 patients had focal seizures, while 1 had generalized epileptic spasm. In scalp EEG, interictal and initial ictal discharges were frontal in 11 and 9 cases, respectively. MRI was indicative of FCD in 10 cases, tumor in 2, tuberous sclerosis and gliosis lesion in 1 case each. 4 patients were MRI negative. 11 patients underwent epileptogenic lesion resections directly and 7 cases received depth electrodes implantation and underwent stereo-electroencephalography to localize epileptogenic zone. At follow-up of 2 years, 14 (77.8%) patients remained seizure-free (Engel Ⅰ), 1 (5.6%) had marked seizure reduction (Engel Ⅱ), 2 (11.0%) showed minor improvement (Engel Ⅲ), and only 1 (5.6%) showed no response (Engel Ⅳ). About predictors of seizure recurrence, there were no significant differences in gender, age at surgery, age of seizure onset, duration of epilepsy, lateralization of epileptogenic zone, positive MRI findings, interictal and ictal discharge, etiology, intellectual development and stereo-electroencephalography implantation, while significantly higher rates of seizure freedom correlated with complete the resection of the epileptogenic zone. Conclusions Focal cortical dysplasia is the most common cause in childhood with frontal lobe epilepsy and complete resection of the epileptogenic zone can lead to good seizure control outcome.

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