Gamma knife therapy in treating epilepsy patients with delayed radiation-induced edema and necrosis in the brain / 中华神经医学杂志

ABSTRACT

Objective To explore the clinical effect of gamma knife treatment in intractable epilepsy patients with delayed radiation-induced cerebral edema and/or necrosis.Methods The clinical feature,EEG,MRI and treatment modality data of 20 patients,admitted to our hospital from 1995 to 2008 and treated with gamma knife,were analyzed retrospectively.In all these patients,14 received conventional medical treatment and 6 adopted surgical removals of necrosis and epileptic focus resulting from the formation of necrotizing lesion,the apparent mass effect and aggravated seizures after conservative treatment.Results Except 1 patient died of cerebral hernia after giving up surgical treatment,all the other patients achieved good results in controlling the epilepsy and headache.Five in the medical group and 2 in the surgical group still needed anti-epileptic drugs.Two patients presented epilepsy of new type because of brain necrosis after radiation therapy and followed EEG demonstrated that radiation-induced delayed cerebral edema and/or necrosis could lead to new epileptogenie focus.Conclusions Radiation-induced cerebral edema and/or necrosis is a common complication in patients with epilepsy after gamma knife treatment which is unpredicted or repeated,thus early diagnosis and treatment are extremely important.Most patients can be cured with such drugs as corticosteroid combined with mannitol or Chinese herbal medicine.However,surgical treatment is needed in controlling the seizures and improving the symptoms once the cystic necrosis lesion,apparent mass effect and new epileptogenic focus appear.