针对耐药焦点的切割性手术:一篇综述
Barbara C Jobst1, Gregory D Cascino2
1Department of Neurology, Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
JAMA
|January 21, 2015
概括
手术显著减少了耐药患者的发作. 虽然有效,但长期结果和患者转诊需要进一步研究.
科学领域:
- 神经外科 神经外科
- 神经学 神经学
- 发病学 (Epileptology) 是一个专业的学科.
背景情况:
- 手术是治疗焦点发作不响应抗药物的治疗方案.
- 患者选择和了解长期结果对于优化手术效益至关重要.
研究的目的:
- 审查针对焦点的切除性手术的结果.
- 确定从手术干预中获益最多的患者子组.
- 探索手术利用不足的原因.
主要方法:
- 对Medline和Cochrane数据库 (1993-2014) 进行了全面的文献搜索.
- 包括的研究包括随机临床试验,元分析,系统审查和大型病例系列 (>300名患者).
- 系统性审查还评估了认知,精神病,生活质量和心理社会结果.
主要成果:
- 随机试验显示,手术后的发作自由率明显高于继续医疗治疗时的发作自由率 (58%-73% vs 0%-8%).
- 总的来说,34%-74%的医疗不耐药患者在手术后实现了无发作.
- 对于叶,海马硬化和良性瘤,结果更为有利,术后死亡率较低 (0.1%-0.5%).
结论:
- 手术是一种有效的治疗方法,可以减少医疗耐药性的活动.
- 长期的认知,精神和生活质量结果需要进一步调查.
- 尽管已证明有效,但患者转诊手术仍然很少发生.
更多相关视频
相关概念视频
Epilepsy and Seizures: Overview
Epilepsy is a chronic neurological disease marked by recurrent, unpredictable seizures. These seizures are caused by abnormal electrical discharges in the brain, leading to behavior, sensation, or consciousness alterations. They can also cause transient impairment of awareness, interfering with daily activities.
Various factors can trigger epilepsy, including genetic factors, brain damage, metabolic causes, and unknown etiology. Diagnosis of epilepsy involves electroencephalography (EEG), which...
Various factors can trigger epilepsy, including genetic factors, brain damage, metabolic causes, and unknown etiology. Diagnosis of epilepsy involves electroencephalography (EEG), which...
Seizures: Classification
Epilepsy is primarily characterized by unpredictable seizures, either provoked by an identifiable factor, such as injury or illness, or unprovoked, occurring spontaneously without apparent cause.
Seizures are typically classified into two main categories: focal and generalized seizures.
Focal Seizures
Focal seizures originate from specific regions of the brain. These seizures are further sub-classified into two types:
Seizures are typically classified into two main categories: focal and generalized seizures.
Focal Seizures
Focal seizures originate from specific regions of the brain. These seizures are further sub-classified into two types:
Antiepileptic Drugs: Glutamate Antagonists
Glutamate is a fundamental neurotransmitter in the central nervous system, playing a vital role in neuronal communication and various cognitive processes. Glutamate stands as the principal excitatory neurotransmitter in the brain. Its presence is crucial for the communication between neurons, underpinning essential processes such as synaptic transmission, neuronal excitability, and plasticity. These functions are vital for higher-order cognitive processes, including learning and memory. The...
Antiepileptic Drugs: Modulators of Neurotransmitter Release Mediated by SV2A Protein
Antiepileptic drugs, such as levetiracetam (Keppra) and brivaracetam (Briviact), have emerged as crucial tools in managing epilepsy. These medications exert their therapeutic effects by targeting the synaptic vesicle protein SV2A, a transmembrane glycoprotein primarily found in the brain.
SV2A is a transmembrane glycoprotein located predominantly in the brain, modulating the release of neurotransmitters for neuronal communication. Both levetiracetam and brivaracetam exhibit a high affinity for...
SV2A is a transmembrane glycoprotein located predominantly in the brain, modulating the release of neurotransmitters for neuronal communication. Both levetiracetam and brivaracetam exhibit a high affinity for...
Antiepileptic Drugs: Potassium Channel Activators
Ezocgabine or retigabine, an antiepileptic drug of remarkable efficacy, has revolutionized the management of seizures. It is a potassium channel activator, explicitly targeting the family of Q subtype potassium channels. It enhances the transmembrane potassium currents, regulating neuronal excitability. This action stabilizes the resting membrane potential, a pivotal factor in mitigating the hyperexcitability that characterizes epilepsy.
Ezogabine has gained approval as an adjunctive treatment...
Ezogabine has gained approval as an adjunctive treatment...
Epilepsy ll: Types
Recurrent seizures, stemming from abnormal electrical activity in the brain, are the defining characteristic of epilepsy, a chronic neurological condition. Because seizure features vary greatly, epilepsy is classified using two systems: by seizure type and by epilepsy syndromes. These classifications enable clinicians to describe seizure patterns and select suitable treatment strategies.I. Classification by Seizure Type1. Focal EpilepsyFocal epilepsy begins in one hemisphere of the brain.


