Drug-resistant Epilepsy and Surgery

Introduction: Epilepsy is one of the most common diseases of the nervous system that occurs due to excessive brain neuronal drainage. Although many medications have been produced for treating epilepsy in recent years, many patients still do not respond to medication. Currently, surgical treatment is one of the most important ways of treating this type of patient. Current surgical procedures for drug-resistant epilepsy are classified into two categories of Resective surgeries and palliative surgeries. Mesial Temporal Lobe Epilepsy Resection is a method that includes anterior temporal lobectomy and selective amygdalohippocampectomy. Some studies have shown that approximately 52% of surgically treated patients did not show any epilepsy attack for up to 10 years. Exteratemporal lobe epilepsy resection is one of the methods used for those patients who had epilepsy induced by ischemic changes, tumor, vascular malformations. This technique is more common in children with progressive cortical dysplasia with diffuse epileptogenic zones. Hemispherectomy is commonly performed in hemiconvulsions hemiplegia epilepsy syndrome,unilateral hemispheric cerebral malformations and perinatal injury. Studies have shown 77% improvement in patients with drug-resistant epilepsy and had this surgical procedure. Neurological deficit such as cerebral palsy is major complications of this procedure. Corpus Callosotomy is applicable for those who had secondary generalized epilepsy, Lennox-like syndrome or Lennox–Gastaut syndrome. In this method, destroying the connector fiber between hemispheres, preventing seizures spread to the opposite side. Studies have suggested that this method is effective in reducing seizure, but disconnection syndrome and motor and memory dysfunction are the most complications of this method.Multiple Subpial Transection is used in the epilepsy types where the epileptogenic zones are observed to be located in vision, language, motor and sensory function areas. Epileptic discharge is performed by the horizontal direction of the cortex. As a result, subpial transection can block the epileptic discharge pathway and reserve the activity of the functional areas. Conclusion: Considering the progression of neurosurgery, in recent years, various procedures have been proposed for the treatment of drug-resistant epilepsy, that each of them has some advantages and disadvantages. Therefore, a systematic review is required to conclude and select the appropriate method.

کلیدواژه ها:

Drug-resistant Epilepsy ، Surgery ، Epilepsy