Dirençli epilepsili çocuklarda ilaç dışı tedavinin etkinliği
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Date
2019
Authors
Vural, Özge
Serdaroglu, Ayse
Kurt, Aysegul Nese Citak
Hirfanoğlu, Tuğba
Kurt, Gökhan
Journal Title
Journal ISSN
Volume Title
Publisher
Uludağ Üniversitesi
Abstract
GİRİŞ ve AMAÇ: Epilepsi en yaygın kronik, nörolojik bozukluklardan biridir. Halen epilepsi tedavisinde eski ve yeni çok çeşitli antiepileptik ilaç kullanılmaktadır. Bu antiepileptik ilaçların kullanımına rağmen hastaların yaklaşık %20-30’u başarılı bir şekilde tedavi edilemez. Bu hasta grubuna ilaca dirençli epilepsi hastaları denir. Dirençli epilepsi hastalarında nöbetlerin sıklığı hastanın yaşam kalitesini ve bilişsel fonksiyonlarını olumsuz etkiler. Günümüzde epilepsi cerrahisi uygulamaları ile başarılı sonuçlar elde edilmektedir. Bu çalışmanın amacı; dirençli epilepsili çocuklarda epilepsi cerrahisinin (rezektif/vagal sinir stimülasyonu) etkinliğini değerlendirmekti. YÖNTEM ve GEREÇLER: Gazi Üniversitesi Tıp Fakültesi Çocuk Nöroloji Bilim Dalı Uzun Süreli Video EEG Monitorizasyon Ünitesinde epilepsi tanısı ile izlenen ve epilepsi cerrahi konseyi kararına göre epilepsi cerrahisi uygulanan 62 çocuk hastanın özellikleri incelendi. BULGULAR: Hastalardan 48’ine vagal sinir stimülasyonu (VSS), 14’üne rezektif cerrahi uygulandı, 31’i kız, 31’i erkek ve nöbet başlangıç yaşı 35,2 + 37,0 ay, cerrahi uygulanma yaşı 11,9 + 3,8 yaş, cerrahi öncesi izlem süresi 8,7 + 4,1 yıl idi. Rezektif cerrahi uygulanan hastalardan 12’si halen nöbetsiz iken, vagal sinir stimülasyonu yapılan hastalardan 3’ü nöbetsiz, 1 hastada %90’dan fazla, 7 hastada %75’den fazla, 19 hastada %50’den fazla nöbet kontrolü sağlanmıştır. TARTIŞMA ve SONUÇ: Sonuç olarak; gerek rezektif cerrahi gerekse VSS ilaca dirençli epilepsisi olan çocuk hastalarda uygulanan etkili tedavi yöntemleridir. VSS görece güvenli ve hafif yan etkileri olan bir yöntemdir. Erken dönemde, uygun hastalara uygulanan rezektif epilepsi cerrahisinin mortaliteyi azalttığı görülmüştür. Epilepsi hastalarında uygun cerrahi yöntem ve uygun hasta seçimi ile nöbet kontrolü büyük ölçüde sağlanabilmektedir. Uzun dönem izlenen seriler bize bu tedavi yöntemlerinin etkinliğini ve avantajlarını daha iyi gösterecektir. Daha etkili yöntemler bulunana kadar VSS ve rezektif cerrahi, ilaca dirençli epilepsi hastalarında cazip tedavi yöntemleri olmaya devam edecektir.
INTRODUCTION: Epilepsy is one of the most common chronic neurological disorders. Currently, a variety of older and newer AEDs are used in the treatment of epilepsy. Despite the use of these AEDs, about 20-30% of patients are not succesfully treated. This group of patients is called pharmacoresistant epilepsy patients. The frequency of seizures in patients with refractory epilepsy, adversely affects the quality of life and cognitive functions. Today, successful results are obtained from the epilepsy surgery. The purpose of this study was to evaluate the efficacy of epilepsy surgery (resective/VNS) in children with pharmacoresistant epilepsy. METHODS: This study was conducted among 62 children that were followed in Gazi University department of neurology long-term video EEG monitorization unit, with the diagnosis of epilepsy. They underwent the epilepsy surgery with the decision of the epilepsy surgery council. RESULTS: The study included 48 patients that underwent VNS treatment and 14 patients that underwent resective surgery. 31 patient were girls, 31 patients were boys, age at onset of seizures (range) was 35,2 + 37,0 months, age at epilepsy surgery was 11,9 + 3,8 years, time before epilepsy surgery was 8,7 + 4,1 years. 12 patients that underwent resective surgery were seizure free, 3 patients with VNS implantation were seizure free after surgery. Seizure reduction > %90 was achieved in 1 patient, > % 75 in 7 patients and > % 50 in 19 patients. DISCUSSION and CONCLUSION: In conclusion resective surgery and VNS are effective treatment methods in children with pharmacoresistant epilepsy. VNS is relatively safe. In early period, resective epilepsy surgery for appropriate patients reduces the mortality. With appropriate patient and appropriate surgical method selection in patients with epilepsy, seizure control can be achieved largely. Until more effective therapies are developed, VNS and resective surgery will remain attractive alternatives for pharmacoresistant epilepsy.
INTRODUCTION: Epilepsy is one of the most common chronic neurological disorders. Currently, a variety of older and newer AEDs are used in the treatment of epilepsy. Despite the use of these AEDs, about 20-30% of patients are not succesfully treated. This group of patients is called pharmacoresistant epilepsy patients. The frequency of seizures in patients with refractory epilepsy, adversely affects the quality of life and cognitive functions. Today, successful results are obtained from the epilepsy surgery. The purpose of this study was to evaluate the efficacy of epilepsy surgery (resective/VNS) in children with pharmacoresistant epilepsy. METHODS: This study was conducted among 62 children that were followed in Gazi University department of neurology long-term video EEG monitorization unit, with the diagnosis of epilepsy. They underwent the epilepsy surgery with the decision of the epilepsy surgery council. RESULTS: The study included 48 patients that underwent VNS treatment and 14 patients that underwent resective surgery. 31 patient were girls, 31 patients were boys, age at onset of seizures (range) was 35,2 + 37,0 months, age at epilepsy surgery was 11,9 + 3,8 years, time before epilepsy surgery was 8,7 + 4,1 years. 12 patients that underwent resective surgery were seizure free, 3 patients with VNS implantation were seizure free after surgery. Seizure reduction > %90 was achieved in 1 patient, > % 75 in 7 patients and > % 50 in 19 patients. DISCUSSION and CONCLUSION: In conclusion resective surgery and VNS are effective treatment methods in children with pharmacoresistant epilepsy. VNS is relatively safe. In early period, resective epilepsy surgery for appropriate patients reduces the mortality. With appropriate patient and appropriate surgical method selection in patients with epilepsy, seizure control can be achieved largely. Until more effective therapies are developed, VNS and resective surgery will remain attractive alternatives for pharmacoresistant epilepsy.
Description
Keywords
Epilepsi, Epilepsi cerrahisi, Vagal sinir stimülasyonu, Epilepsy, Epilepsy surgery, Vagal nerve stimulation
Citation
Vural, Ö. vd. (2019). "Dirençli epilepsili çocuklarda ilaç dışı tedavinin etkinliği". Güncel Pediatri, 17(2), 243-252.