Farmakorezistentní epilepsie po kraniocerebrálním poranění
| Title in English | Pharmacoresistant epilepsy after craniocerebral injury |
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| Authors | |
| Year of publication | 2012 |
| Type | Article in Periodical |
| Magazine / Source | Rozhledy v Chirurgii |
| MU Faculty or unit | |
| Citation | |
| Web | http://www.prolekare.cz/rozhledy-v-chirurgii-clanek/farmakorezistentni-epilepsie-po-kraniocerebralnim-poraneni-38401?search= |
| Field | Neurology, neurosurgery, neurosciences |
| Keywords | Head injury; Epilepsy; Surgical treatment; Vagus nerve stimulation |
| Description | Increasing incidence of both open and closed craniocerebral injuries can be observed at present time. Posttraumatic epilepsy is one of the possible serious consequencies of head injury with clinical manifestation months or years after surgery. In pharmacoresistant patients surgical therapy should be considered. The study summarises the results of surgical treatment of pharmacoresistant posttraumatic epilepsy in a group of 13 patients (11 males and 2 females). Average age at the time of injury was 9.6 years in males and 8.8 years in females. Average number of seizures was 10.7 – 17 seizures/month preoperatively. Invasive EEG monitoring was required in 5 patients in whom non invasive or semiinvasive investigations failed to localize the epileptogenic zone adequately. Temporal lobe resections were performed in 4 patients, 4 patients underwent extratemporal resections and vagus nerve stimulation system was implanted in 5 patients. Three patients (75 %) after temporal resections became seizure free (Engel I) and in the remaining patient significant reduction of seizures was achieved (Engel III). There were 2 seizure free patients after extratemporal resections (50 %) and significant reduction of seizures was achieved (Engel III) in the remaining two. One patient after vagus nerve stimulation met the criteria for > 90 % response and there was 50 - 90 % seizures reduction in the remaining 4 patients (vagus nerve stimulation responder). Although in limited group of patients the study confirms good results of surgical treatment of selected posttraumatic epilepsy patients - mainly temporal epilepsy patiens and patiens after vagus nerve stimulation. Meticulous presurgical evaluation including invasive encephalography in indicated patiens is a precondition for surgical success. |
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