识别和治疗可通过手术修复的婴儿癫痫痉挛综合征病因。

IF 3.4 2区 医学 Q2 CLINICAL NEUROLOGY Expert Review of Neurotherapeutics Pub Date : 2024-07-01 Epub Date: 2024-05-30 DOI:10.1080/14737175.2024.2360117
Emma Macdonald-Laurs, Winston Dzau, Aaron E L Warren, Matthew Coleman, Cristina Mignone, Sarah E M Stephenson, Katherine B Howell
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引用次数: 0

摘要

简介婴幼儿癫痫痉挛综合征(IESS)是一种常见的发育性癫痫性脑病,长期治疗效果不佳。相当一部分婴儿癫痫痉挛综合征患者的病因有可能通过手术得到治疗。尽管如此,癫痫手术在这一患者群体中的使用率却很低。一些可通过手术修复的病因,如局灶性皮质发育不良和癫痫性少突胶质增生性皮质发育畸形(MOGHE),在婴幼儿中诊断不足。即使认识到了可通过手术补救的病因,例如结节性硬化症或局灶性脑瘤,癫痫手术也可能因弥漫性脑电图改变、手术界限不清或担心在这一年龄组进行手术而被推迟或不予考虑:在这篇综述中,作者讨论了可通过手术治疗的常见 IESS 病因、其临床和脑电图特征以及有助于诊断的影像学技术。然后,他们介绍了用于这类患者的手术方法,以及早期癫痫手术对发育中的大脑网络的有益影响:癫痫手术仍然未得到充分利用,即使已发现潜在的可通过手术补救的病因。克服导致对手术候选者认识不足和对 IESS 癫痫手术利用不足的障碍,将改善癫痫发作和发育的长期预后。
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Identification and treatment of surgically-remediable causes of infantile epileptic spasms syndrome.

Introduction: Infantile epileptic spasms syndrome (IESS) is a common developmental and epileptic encephalopathy with poor long-term outcomes. A substantial proportion of patients with IESS have a potentially surgically remediable etiology. Despite this, epilepsy surgery is underutilized in this patient group. Some surgically remediable etiologies, such as focal cortical dysplasia and malformation of cortical development with oligodendroglial hyperplasia in epilepsy (MOGHE), are under-diagnosed in infants and young children. Even when a surgically remediable etiology is recognised, for example, tuberous sclerosis or focal encephalomalacia, epilepsy surgery may be delayed or not considered due to diffuse EEG changes, unclear surgical boundaries, or concerns about operating in this age group.

Areas covered: In this review, the authors discuss the common surgically remediable etiologies of IESS, their clinical and EEG features, and the imaging techniques that can aid in their diagnosis. They then describe the surgical approaches used in this patient group, and the beneficial impact that early epilepsy surgery can have on developing brain networks.

Expert opinion: Epilepsy surgery remains underutilized even when a potentially surgically remediable cause is recognized. Overcoming the barriers that result in under-recognition of surgical candidates and underutilization of epilepsy surgery in IESS will improve long-term seizure and developmental outcomes.

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来源期刊
Expert Review of Neurotherapeutics
Expert Review of Neurotherapeutics Medicine-Neurology (clinical)
CiteScore
7.00
自引率
2.30%
发文量
61
审稿时长
4-8 weeks
期刊介绍: Expert Review of Neurotherapeutics (ISSN 1473-7175) provides expert reviews on the use of drugs and medicines in clinical neurology and neuropsychiatry. Coverage includes disease management, new medicines and drugs in neurology, therapeutic indications, diagnostics, medical treatment guidelines and neurological diseases such as stroke, epilepsy, Alzheimer''s and Parkinson''s. Comprehensive coverage in each review is complemented by the unique Expert Review format and includes the following sections: Expert Opinion - a personal view of the data presented in the article, a discussion on the developments that are likely to be important in the future, and the avenues of research likely to become exciting as further studies yield more detailed results Article Highlights – an executive summary of the author’s most critical points
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