Epilepsy is one of the most common neurological disorders, with a high disability rate, recurrent seizures and a long course. It is a serious threat to the physical and mental health of patients (especially adolescent patients), preventing them from living, working and studying normally, affecting the quality of life of patients and their family members, and increasing the economic burden. Met Tao, Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University
According to the latest domestic statistics, the prevalence of epilepsy in China is 0.7%, according to which it is estimated that there are currently about 9 million epilepsy patients in China, while the number of new patients increases by about 400,000 each year. About 60%-80% of epilepsy patients can control their clinical seizures with conventional antiepileptic drug treatment. However, about 20%-30% of patients respond poorly to drug therapy, called refractory epilepsy, which mainly refers to cases in which regular application of single drug or multi-drug combination therapy is not effective for more than a certain period of time. This group of patients has a relatively long course of treatment and can be associated with intellectual disability and neurological complications, in addition to frequent seizures.
Causes
The causes of epilepsy are many and complex. In general, they can be broadly divided into primary epilepsy and secondary epilepsy. Primary epilepsy is epilepsy that does not have an underlying cause other than genetic factors, meaning that the various tests that are currently available have not been able to prove that there is an organic lesion in the brain that causes seizures or that there are signs of systemic metabolic disease. Secondary epilepsy, also known as symptomatic epilepsy, is epilepsy for which a clear cause can be found. Common causes of secondary epilepsy include prenatal or intrapartum injury, craniocerebral trauma, congenital cortical developmental abnormalities, intracranial infections, brain tumors, cerebrovascular disease, metabolic disorders, poisoning, or other causes. This classification is also relative. With the progress of medical science and the continuous introduction of advanced medical instruments, the detection rate of brain lesions has greatly increased, and some of the epilepsy that could not be found can find its cause, so it can also be called cryptogenic epilepsy.
Drug treatment
Medication is the basic treatment for epilepsy, but several principles must be followed.
(1) The diagnosis of epilepsy must be clear.
(2) Regular and rational use of medication.
(3) individualization of medication.
(4) Strict drug monitoring.
Surgical treatment
Surgery is an important tool in the treatment of refractory epilepsy and secondary epilepsy, and appropriate surgery can control or cure seizures in many patients. There are various methods of surgery, but the only procedure that is internationally recognized as having the most definite efficacy is epileptic focal resection. Other surgeries include corpus callosotomy, multiple floppy meningeal transverse fiber dissection, cortical transverse fiber thermal cautery, stereotactic disruption, vagus nerve stimulation, deep brain electrical stimulation, etc. These are all palliative procedures applied in specific cases, which can control seizures to some extent, but hardly achieve a cure.
The key to successful epilepsy surgery is an adequate preoperative evaluation and accurate localization of the epileptic focus.
Methods of preoperative examination and evaluation include.
(1) high-resolution magnetic resonance imaging (MRI) scan.
(2) long-range video electroencephalogram monitoring (V-EEG).
(3) functional imaging such as PET/SPECT.
(4) functional magnetic resonance imaging (fMRI).
(5) neuropsychological evaluation.
(6) long-range intracranial EEG recording with embedded intracranial electrodes.
(7) localization of stimulation of motor, language, sensory and other functional brain cortex, etc.
Postoperative precautions
1. to continue taking medication for more than 3 years after surgery as prescribed by the doctor.
2. regular monitoring of blood drug concentration, liver and kidney function, blood routine, etc.
3. regularly recheck V-EEG. 4;
4. If there is no seizure for 3 years after surgery, the medication can be gradually reduced to stop under the guidance of the doctor.
Reasonable preoperative examination and evaluation process
Patients with outpatient diagnosis of refractory epilepsy