ABSTRACT
Objective To retrospectively analyze the effect and safety of bilateral stereotactic radiofrequency amygdalohippocampectomy (SAHE) for treatment of bilateral medial temporal lobe epilepsy (BMTLE). Methods Twelve BMTLE patients were treated with bilateral SAHE under limited coagulations. Clinical parameters were evaluated with the programs of Engel′s classification, Liverpool Seizure Severity Scale (LSSS) 2.0, Wechsler Adult Intelligence Scale-Revised (WAIS-R) and Wechsler Memory Scale-Revised (WMS-R), respectively. Results Five patients (42%) were assessed as EngelⅠwith 12 ~ 62-month follow-up. Seizure severity scores were declined sharply compared with the baseline of the patients with out seizure free. Function of memory and intelligence was transiently declined without statistical significance immediately after operation (P >0.05), but was significantly increasedat 6 months after operation (P < 0.05). Conclusion Bilateral SAHE could terminate seizures or reduce seizure severity in patients with BMTLE. Under the circumstance of limited coagulations, neuropsychological function was improved along with seizure control.
ABSTRACT
<p><b>OBJECTIVE</b>Multiple subpial transection (MST) is one approach to the surgical treatment of intractable epilepsy with epileptogenic lesion located in functional areas. To verify the effect of MST, an experimental study was performed first, followed by clinical application.</p><p><b>METHODS</b>On the basis of the experimental study, MST was performed in 200 intractable epileptic patients from 1991 to 2000. Of them, 80 cases underwent MST only while 120 others underwent MST combined with other techniques, such as corpus callosotomy, temporal lobectomy and focus resection. A series of modifications of the surgical techniques were made.</p><p><b>RESULTS</b>The results of the experimental study indicated that MST could inhibit the formation and spreading of epileptic discharge and limit the damage to neurons in a minimal area on the epileptogenic agent injected cortex. MST does not impair major functions of the cortex. After the clinical application and modifications, 160 patients were followed up for 1 to 8 years. Complete control of seizure was obtained in 100 cases (62.5%), significant reduction (more than 75%) in 32, reduction (more than 50%) in 20 and no change in 8. The total rate of effectiveness was 95.0%, and the significant rate of effectiveness was 82.5%. No functional defects were found in any patients.</p><p><b>CONCLUSIONS</b>The results indicate that MST is an effective approach to the surgical treatment of intractable epilepsy. MST can be combined with other approaches. The outcome of the subdivision of the MST only group indicates that MST on local epileptogenic lesion without structural changes is as effective as that of the combined operation group. To evade hemispheric disturbance, MST should be done first to avoid severe complications. Hemispherectomy should be performed only on poor effected cases of MST.</p>
Subject(s)
Adolescent , Adult , Child , Child, Preschool , Female , Humans , Male , Middle Aged , Epilepsy , General Surgery , Pia Mater , Surgical Procedures, Operative , MethodsABSTRACT
With Modified Webster Scale, 42 patients suffered from Parkinson disease were examined before and after operation. The symptoms were divided into 10 groups. 1～10 points was taken as slight disability, 11～20 as medium, and 21～30 as severe. Improvement less than 25% was taken as no effect, 26%～50% as effective, 51%～75% as significantly effective, and over 75% as very significantly effective. The score was (19 90?5 27) preoperatively and (10 57?6 10) postoperatively. The mean improvement was (8 95?3 37). Very significantly effective result was obtained in 4 cases (9 5%), significantly effective sesult was obtained in 17 cases (40 5%), and effective result was obtained in 16 cases (38 1%). The total effective rate was 88 1%. One target coagulation was performed in 34 cases, the mean improvement was in (8 59?3 53). Two target coagulation on one side was performed in 8 patients, the mean improvement was in (10 00?4 14). No significant difference was found between these two groups statistically. It is suggested, for patients with Parkinson disease in whom drug treatment is not efficacious or because of increased side effect, Modified Webster Scale is useful to evaluate the effect of surgical treatment. This scale is very easy to use especially for neurosurgeons.