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Expedited epilepsy surgery prior to drug resistance in children: a frontier worth crossing?
Brain ( IF 10.6 ) Pub Date : 2022-07-27 , DOI: 10.1093/brain/awac275
Andrew T Hale 1 , Aswin Chari 2, 3 , Rod C Scott 3, 4, 5 , J Helen Cross 3, 5 , Curtis J Rozzelle 1 , Jeffrey P Blount 1 , Martin M Tisdall 2, 3
Affiliation  

Epilepsy surgery is an established safe and effective treatment for selected candidates with drug-resistant epilepsy. In this opinion piece, we outline the clinical and experimental evidence for selectively considering epilepsy surgery prior to drug resistance. Our rationale for expedited surgery is based on the observations that, 1) a high proportion of patients with lesional epilepsies (e.g. focal cortical dysplasia, epilepsy associated tumours) will progress to drug-resistance, 2) surgical treatment of these lesions, especially in non-eloquent areas of brain, is safe, and 3) earlier surgery may be associated with better seizure outcomes. Potential benefits beyond seizure reduction or elimination include less exposure to anti-seizure medications (ASM), which may lead to improved developmental trajectories in children and optimize long-term neurocognitive outcomes and quality of life. Further, there exists emerging experimental evidence that brain network dysfunction exists at the onset of epilepsy, where continuing dysfunctional activity could exacerbate network perturbations. This in turn could lead to expanded seizure foci and contribution to the comorbidities associated with epilepsy. Taken together, we rationalize that epilepsy surgery, in carefully selected cases, may be considered prior to drug resistance. Lastly, we outline the path forward, including the challenges associated with developing the evidence base and implementing this paradigm into clinical care.

中文翻译:

儿童耐药前的快速癫痫手术:一个值得跨越的前沿?

对于选定的耐药性癫痫患者,癫痫手术是一种安全有效的治疗方法。在这篇评论文章中,我们概述了在耐药之前选择性考虑癫痫手术的临床和实验证据。我们加速手术的基本原理是基于以下观察结果:1) 大部分患有病变性癫痫(例如局灶性皮质发育不良、癫痫相关肿瘤)的患者会发展为耐药性,2) 对这些病变进行手术治疗,尤其是在非-大脑的雄辩区域,是安全的,并且 3) 早期手术可能与更好的癫痫发作结果相关。除了减少或消除癫痫发作之外的潜在好处包括减少接触抗癫痫药物 (ASM)、这可能会改善儿童的发育轨迹,并优化长期的神经认知结果和生活质量。此外,有新出现的实验证据表明,癫痫发作时存在大脑网络功能障碍,持续的功能障碍活动可能会加剧网络扰动。这反过来可能导致癫痫病灶扩大,并导致与癫痫相关的合并症。综上所述,我们认为在精心挑选的病例中,可以在耐药性发生之前考虑进行癫痫手术。最后,我们概述了前进的道路,包括与开发证据基础和将这种范式应用于临床护理相关的挑战。有新出现的实验证据表明,癫痫发作时存在大脑网络功能障碍,持续的功能障碍活动可能会加剧网络扰动。这反过来可能导致癫痫病灶扩大,并导致与癫痫相关的合并症。综上所述,我们认为在精心挑选的病例中,可以在耐药性发生之前考虑进行癫痫手术。最后,我们概述了前进的道路,包括与开发证据基础和将这种范式应用于临床护理相关的挑战。有新出现的实验证据表明,癫痫发作时存在大脑网络功能障碍,持续的功能障碍活动可能会加剧网络扰动。这反过来可能导致癫痫病灶扩大,并导致与癫痫相关的合并症。综上所述,我们认为在精心挑选的病例中,可以在耐药性发生之前考虑进行癫痫手术。最后,我们概述了前进的道路,包括与开发证据基础和将这种范式应用于临床护理相关的挑战。在精心挑选的病例中,可以在耐药性之前考虑。最后,我们概述了前进的道路,包括与开发证据基础和将这种范式应用于临床护理相关的挑战。在精心挑选的病例中,可以在耐药性之前考虑。最后,我们概述了前进的道路,包括与开发证据基础和将这种范式应用于临床护理相关的挑战。
更新日期:2022-07-27
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