Epilepsy is a common neurological disorder, a chronic brain disorder caused by a variety of causes and characterized clinically by sudden, recurrent and transient central nervous system malfunctions due to excessive electrical issuance of neurons in the brain as a physiological basis.
I. Incidence.
In the nervous system its incidence is second only to stroke. The prevalence in China is 0.4%, with a domestic population of about 6.5 million and 1.5 million with refractory epilepsy. The so-called refractory epilepsy, also known as intractable epilepsy, is currently considered to be intractable epilepsy if the following conditions are met: more than 4 years of disease duration, seizures greater than 4 times / month, long-term, standardized, adequate anti-seizure treatment still have seizures, frequent seizures, seriously affect work and life.
Second, comprehensive localization techniques for epilepsy source.
1, electrophysiological localization: EEG, Video-EEG, dynamic EEG.
2.Imaging localization: MRI, functional MRI, magnetic resonance spectroscopy (MRS).
3.Brain metabolic localization: SPECT, PET.
III. Treatment
1.Medication
2.Surgical treatment
(1) Indications: refractory epilepsy; secondary epilepsy: imaging with structural and/or organic changes , lesions associated with seizures, resection does not produce severe neurological deficits.
(2) Common epileptogenic lesions that can cause seizures and be treated surgically: post-traumatic epilepsy, meningeal-brain scars, depressed fractures, intracranial foreign bodies, post-encephalitis, meningitis and brain abscesses, cerebral parasitic disease, brain tumors, malformation tumors, cerebrovascular disease (cerebral AVM, cavernous hemangioma, post-stroke or ischemia, Sturge-Webber syndrome), medial temporal lobe lesions (hippocampal sclerosis , choroidal fissure cysts);
tuberous sclerosis, infantile hemiplegia with intractable epilepsy, congenital developmental anomalies (hemispheric macrocephaly, cerebral penetrating malformations, cysts, various cortical developmental anomalies cortical migrations, multiple microcephalic gyrus, cerebral fissure malformations, gray matter ectopia) specific epileptic syndromes (infantile spasms (West syndrome) Lennox-Gastaut syndrome Landau-Kleffner syndrome, etc. Rasmussen’s encephalitis). In infants and children, if the diagnosis of catastrophic epilepsy is clear, the earlier the surgery, the better.
(3) The following surgical approaches are broadly carried out.
① Prefrontal lobectomy and resection of cortical lesions outside the frontal lobe.
(2) Cerebral hemispherectomy.
(3) Combined cerebral dissection. Most of them use anterior corpus callosotomy or selective fenestration;
(iv) Multiple subchondral transverse fiber resections. It can obtain epilepsy control and protect normal cortical function;
(5) Subcerebral disruption of structures in the subdivision of the brain.
(6) Chronic cerebellar stimulation.
(vii) Intracerebral transplantation.