Lennox-Gastaut綜合征患者的手術選擇_Journal of Epilepsy

Authors：

 DouglassLM , SalpekarJ , 蔣忱希 , 楊小楓

Corresponding?author：

DouglassLM, Email: lauric.douglass@bmc.org

Keywords：

癲癇; 兒童; 胼胝體切開術; 切除性手術

DOI：

10.7507/2096-0247.20160065

Video：

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盡管目前關于Lennox-Gastaut綜合征（LGS）患者藥物治療的研究越來越多，但藥物治療的效果研究仍然不令人滿意。在許多情況下，LGS仍然是難治性的且導致包括智力低下，持續性癲癇發作和一些精神疾病等不良預后。對其他治療方式無效的LGS患者進一步的選擇是手術治療。術前評估應包括發作間期腦電圖（EEG）、磁共振成像（MRI）分析和年齡相關的神經/發育評估。手術切除癲癇灶可以在很多患者成功的控制癲癇發作，尤其是病灶切除術或者腦葉切除術效果較好。最近的有關報道肯定了LGS患者手術切除的效果，大部分患者的癲癇發作得到有效的控制。胼胝體切開術是一種姑息性的手術方式，其目的是通過防止癲癇活動向雙側半球擴散來控制潛在的損傷性發作。例如，對于失張力或跌倒性發作，它具有高發病率和高死亡率，顯微外科手術限制于胼胝體前部，大大降低了胼胝體切開術的手術并發癥。迷走神經刺激是另一種姑息治療方式，迷走神經刺激的療效與胼胝體切開術類似，但在失張力發作中，胼胝體切開術療效更好。外科手術技術的最新進展為LGS患者提供了更多有效的治療選擇。

Citation： DouglassLM, SalpekarJ, 蔣忱希, 楊小楓. Lennox-Gastaut綜合征患者的手術選擇. Journal of Epilepsy, 2016, 2(4): 366-372. doi: 10.7507/2096-0247.20160065 Copy

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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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