Epilepsiechirurgie

Zusammenfassung

Die Epilepsiechirurgie kann bei einem erheblichen Teil der Patienten mit unzureichender Anfallskontrolle unter medikamentöser antiepileptischer Therapie Anfallsfreiheit erzielen. Günstige Faktoren für das Erzielen einer vollständigen Anfallskontrolle sind Patienten, bei denen Lage und Größe des Fokus eine vollständige Resektion ermöglichen, bei denen der kernspintomografische Nachweis– auch unter Einsatz neuer hochauflösender Bildgebungsmethoden– Hinweise auf das epileptogene Areal gibt, bei denen die Ergebnisse der multimodalen prächirurgischen Diagnostik konkordant auf ein epileptogenes Areal hinweisen, die nicht an sekundär generalisierten tonisch-klonischen Anfällen leiden und frühzeitig operiert werden. Operierte Patienten haben gute Chancen, auch psychosoziale Ziele zu verwirklichen: Sie haben insbesondere bei einem Erzielen von Anfallsfreiheit verbesserte berufliche und soziale Chancen, gewinnen an Mobilität und bewerten insgesamt ihre Lebensqualität besser als Patienten, bei denen trotz Pharmakoresistenz medikamentöse Therapieversuche fortgesetzt werden. Wahrscheinlich ist auch das Risiko unerwarteter Todesfälle (SUDEP) vermindert. Die Realisierbarkeit eines Lebens ohne Medikamenteneinnahme wird derzeit noch kontrovers bewertet, und es besteht kein Konsens über Absetzstrategien nach einem epilepsiechirurgischen Eingriff. Hingegen besteht gute Evidenz dafür, dass die Erhaltung guter kognitiver Leistungen durch entsprechende Patientenauswahl und Operationsplanung von hohem Wert für die Patienten ist.

Summary

Epilepsy surgery can lead to seizure freedom also in a considerable percentage of patients with insufficient seizure control under phamacotherapy. Positive predictors for complete seizure control are localization and extension of the focus allowing for a complete removal, evidence for a structural lesion using– advanced–imaging, absence of generalized tonic-clonic seizures, and early surgical therapy. Patients havea good chance to achieve also psychosocial aims: particularly in case of seizure freedom they have better vocational chances and interpersonal relationships, they gain in mobility and rate their quality of life as higher compared to patients continuing medical treatment. The risk of sudden unexpected deaths may be reduced after successful epilepsy surgery. There is an ongoing debate on how many patients can live postoperatively without medication, and regarding the way antiepileptic drugs should be tapered. The preservation of cognitive capabilities by patient selection and optimal planning of surgery has significant impact on postoperative living.

Schlüsselworte

Epilepsiechirurgie - Outcome - Anfallsfreiheit - Prädiktoren - Ziele - Psychosoziale Faktoren - Antiepileptika-Kognition

Keywords

Epilepsy surgery - outcome - seizure freedom - predictors - aims - psychosocial factors - antiepileptica-cognition

• Literatur

• 1 Abosch A, Bernasconi N, Boling W, Jones-Gotman M, Poulin N, Dubeau F, Andermann F, Olivier A. Factors predictive of suboptimal seizure control following selective amygdalohippocampectomy. J Neurosurg 2002; 97: 1142-1151.
• 2 Anhoury S, Brown RJ, Krishnamoorthy ES, Trimble MR. Psychiatric outcome after temporal lobectomy: a predictive study. Epilepsia 2000; 41: 1608-1615.
• 3 Annegers JF, Hauser WA, Elveback LR. Remission of seizures and relapse in patients with epilepsy. Epilepsia 1979; 20: 729-737.
• 4 Armon C, Radtke RA, Friedman AH, Dawson DV. Predictors of outcome of epilepsy surgery: multiveriate analysis with validation. Epilepsia 1996; 37: 814-821.
• 5 Aronica E, Leenstra S, van Veelen CW, van Rijen PC, Hulsebos TJ, Tersmette AC, Yankaya B, Troost D. Glioneuronal tumors and medically intractable epilepsy: a clinical study with long-term followup of seizure outcome after surgery. Epilepsy Res 2001; 43: 179-191.
• 6 Arruda F, Cendes F, Andermann F, Dubeau F, Villemure JG, Jones-Gotman M, Poulin N, Arnold DL, Olivier A. Mesial atrophy and outcome after amygdalohippocampectomy or temporal lobe removal. Ann Neurol 1996; 40: 446-450.
• 7 Baxendale S, Thompson P, Harkness W, Duncan J. Predicting memory decline following epilepsy surgery: a multivariate approach. Epilepsia 2006; 47: 1887-1894.
• 8 Bertram EH. Why does surgery fail to cure limbic epilepsy? Seizure functional anatomy may hold the answer. Epil Res 2003; 56: 93-99.
• 9 Bien CG, Schulze-Bonhage A, Soeder BM, Schramm J, Elger CE, Tiemeier H. Assessment of the long-term effects of epilepsy surgery with three different reference groups. Epilepsia 2006; 47: 1865-1869.
• 10 Boesebeck F, Janszky J, Kellinghaus C, May T, Ebner A. Presurgical seizure frequency and tumoral etiology predict the outcome after extratemporal epilepsy surgery. J Neurol. 2007 (Epub ahead of print).
• 11 Chan CH, Bittar RG, Davis GA, Kalnins RM, Fabinyi GC. Long-term seizure outcome following surgery for dysembryoplastic neuroepithelial tumor. J Neurosurg 2006; 104: 62-69.
• 12 Dulay MF, York MK, Soety EM, Hamilton WJ, Mizrahi EM, Goldsmith IL, Verma A, Grossman RG, Yoshor D, Armstrong DD, Levin HS. Memory, emotional and vocational impariments before and after anteror temporal lobectomy for complex partial seizures. Epilepsia 2006; 47: 1922-1930.
• 13 Dupont S, Tanguy ML, Clemenceau S, Adam C, Hazemann P, Baulac M. Long-term prognosis and psychosocial outcomes after surgery for MTLE. Epilepsia 2006; 47: 2115-2124.
• 14 Fauser S, Altenmüller D, Schulte-Mönting J, Bast T, Strobl K, Steinhoff BJ, Zentner J, Schulze-Bonhage A. Factors influencing surgical outcome in focal cortical dysplasia. J Neurol Neurosurg Psychiatry. 2007 in Druck.
• 15 Fauser S, Schulze-Bonhage A, Honegger J, Carmona H, Huppertz HJ, Pantazis G, Rona S, Bast T, Strobl K, Steinhoff BJ, Korinthenberg R, Rating D, Volk B, Zentner J. Focal cortical dysplasias: surgical outcome in 67 patients in relation to histological subtypes and dual pathology. Brain 2004; 127: 2406-2418.
• 16 Gilliam F, Wyllie E, Kashden J, Faught E, Kotagal P, Bebin M, Wise M, Comair Y, Morawetz R, Kuzniecky R. Epilepsy surgery outcome: comprehensive assessment in children. Neurology 1997; 48: 1368-1374.
• 17 Grunwald T, Lehnertz K, Helmstaedter C, Kutas M, Pezer N, Kurthen M, Van Roost D, Elger CE. Limbic ERPs predict verbal memory after left-sided hippocampectomy. Neuroreport 1998; 09: 3375-3378.
• 18 Hamiwka L, Jayakar P, Resnick T, Morrison G, Ragheb J, Dean P, Dunoyer C, Duchowny M. Surgery for epilepsy due to cortical malformations: ten-year follow-up. Epilepsia 2005; 46: 556-560.
• 19 Hardy SG, Milller JW, Holmes MD, Born DE, Ojemann GA, Dodrill CB, Hallam DK. Factors predicing outcome of surgery for intractable epilepsy with pathologically verified mesial temporal sclerosis. Epilepsia 2003; 44: 565-568.
• 20 Helmstaedter C, Kockelmann E. Cognitive outcomes in patients with chronic temporal lobe epilepsy. Epilepsia 2006; 47 (Suppl. 02) 96-98.
• 21 Helmstaedter C, Kurthen M, Lux S, Johanson K, Quiske A, Schramm J, Elger CE. Temporallappenepilepsie. Längsschnittliche klinische, neuropsychologische und psychosoziale Entwicklung operativ und konservativ behandelter Patienten. Nervenarzt 2000; 71: 629-642.
• 22 Helmstaedter C, Loer B, Wohlfahrt R, Hammen A, Saar J, Steinhoff BJ, Quiske A, Schulze-Bonhage A. Effects of cognitive rehabilitation in patients undergoing temporal lobe epilepsy surgery. Submitted.
• 23 Hermann BP, Wyler AR, Somes G, Berry AD, Dohan FC. Pathological status of the mesial temporal lobe predicts memory outcome from left anterior temporal lobectomy. Neurosurgery 1992; 31: 652-657.
• 24 Holmes MD, Kutsy RL, Ojemann GA, Wilensky AJ, Ojemann LM. Interictal, unifocal spikes in refractory extratemporal epilepsy predict ictal origin and postsurgical outcome. Clin Neurophysiol 2000; 111: 1802-1808.
• 25 Hufnagel A, Zentner J, Fernandez G, Wolf HK, Schramm J, Elger CE. Multiple subpial transection for control of epileptic seizures: effectiveness and safety. Epilepsia 1997; 38: 678-688.
• 26 Jansen FE, van Huffelen AC, Algra A, van Nieuwenhuizen O. Epilepsy Surgery in Tuberous Sclerosis: A Systematic Review. Epilepsia. 2007 (Epub ahead of print).
• 27 Janszky J, Janszky I, Schulz R, Hoppe M, Behne F, Pannek HW, Ebner A. Temporal lobe epilepsy with hippocampal sclerosis: predictors for longterm surgical outcome. Brain 2005; 128: 395-404.
• 28 Jeong S-W, Lee SK, Hong K-S, Kim K-K, Chung C-K, Kim H. Prognostic factors for the surgery for mesial temporal lobe epilepsy: longitudinal analysis. Epilepsia 2005; 46: 1273-1279.
• 29 Jones JE, Berven NL, Ramirez L, Woodard A, Hermann BP. Long-term psychosocial outcomes of anterior temporal lobectomy. Epilepsia 2002; 43: 896-903.
• 30 Koch-Stoecker S. Personality disorders as predictors of severe postsurgical psychiatric complications in epilepsy patients undergoing temporal lobe resections. Epilepsy Behav 2002; 03: 526-531.
• 31 Kral T, von Lehe M, Podiogar M, Clusmann H, Süßmann P, Kurthen M, Becker A, Urbach H, Schramm J. Focal cortical dysplasia: long-term seizure outcome after surgical treatment. J Neurol Neurosurg. 2007 (epub before print).
• 32 Langfitt JT, Westerveld M, Hamberger MJ, Walczak TS, Cicchetti DV, Berg AT, Vickrey BG, Barr WB, Sperling MR, Masur D, Spencer SS. Worsening of quality of life after epilepsy surgery: effect of seizures and memory decline. Neurology 2007; 68: 1988-1994.
• 33 Loddenkemper T, Holland KD, Stanford LD, Kotagal P, Bingaman W, Wyllie E. Developmental outcome after epilepsy surgery in infancy. Pediatrics 2007; 119: 930-935.
• 34 Luyken C, Blümcke I, Fimmers R, Urbach H, Elger CE, Wiestler OD, Schramm J. The spectrum of long-term epilepsy-associated tumors: long-term seizure and tumor outcome and neurosurgical aspects. Epilepsia 2003; 44: 822-830.
• 35 Malmgren K, Sullivan M, Ekstedt G, Kullberg G, Kumli E. Health-related quality of life after epilepsy surgery: a swedish multicenter study. Epilepsia 1997; 38: 830-838.
• 36 McIntosh AM, Kalnins RM, Mitchell LS, Fabinyi CA, Briellmann RS, Berkovic SF. Temporal lobectomy: long-term seizure outcome, late recurrence and risks for seizure recurrence. Brain 2004; 127: 2018-2030.
• 37 McIntosh AM, Wilson SJ, Berkovic SF. Seizure outcome after temporal lobectomy: current research practice and findings. Epilepsia 2001; 42: 1288-1307.
• 38 Mittal S, Montes JL, Farmer J-P, Rosenblatt B, Dubeau F, Andermann F, Poulin N, Olivier A. Longterm outcome after surgical treatment of temporal lobe epilepsy in children. J Neurosurg 2005; 103 (5S) 401-412.
• 39 Mosewich Rk, So EL, O´Brien J, Cascino GD, Sharbrough FW, Marsh WR, Meyer FB, Lack CR, O´Brien PC. Factors predictive of the outcome of frontal lobe epilepsy surgery. Epilepsia 2000; 41: 843-849.
• 40 Palmini A, Andermann F, Olivier F, Tampieri Dv, Robitaille Y. Focal neuronal migration disorders and intractable partial epilepsy: results of surgical treatment. Ann Neurol 1991; 30: 750-757.
• 41 Rausch R, Kraemer S, Petras CJ, Vickrey BG, Passarpo EA. Early and late cognitive changes following temporal lobe surgery for epilepsy. Neurology 2003; 60: 951-959.
• 42 Reid K, Herbert A, Baker GA. Epilepsy surgery: patient-perceived long-term costs and benefits. Epil Behav 2004; 05: 81-87.
• 43 Rhadakrishnan K, So EL, Silbert PL, Jack CR, Cascino GD, Sharbrough FW. Predictors of outcome of anterior temporal lobectomy for intractable epilepsy. Neurology 1998; 51: 465-471.
• 44 Ring HA, Moriarty J, Trimble MR. A prospective study of the early postsurgical psychiatric associations of epilepsy surgery. J Neurol Neurosurg Psychiatry 1998; 64: 601-604.
• 45 Rocamora R, Mader I, Zentner J. Schulze-Bonhage Epilepsy surgery in patients with multiple supratentorial cavernous malformations. Submitted.
• 46 Schmidt D, Baumgartner C, Löscher W. Seizure recurrence after planned discontinuation of antiepileptic drugs in seizure-free patients after epilepsy surgery: a review of current clinical experience. Epilepsia 2004; 45 (02) 179-186.
• 47 Schulze-Bonhage A, Trippel M, Wagner K, Bast T, Ebner A, Elger CE, Keimer R, Mayer T, Quiske A, Steinhoff BJ, Tuxhorn I, Christoph Ostertag. Outcome and predictors of interstitial radiosurgery in the treatment of gelastic epilepsy due to hypothalamic hamartoms. Submitted.
• 48 Schulze-Bonhage A. Ethische Entscheidungkonflikte in der präoperativen Diagnostik und epilepsiechirurgischen Behandlung. In: Maio GJ Clausen und. (Hrsg) Die Natur des Menschen in Neurowissenschaft und Neuroethik. Würzburg: Königshausen & Neumann; 2007. im Druck.
• 49 Schulze-Bonhage A. Langzeitoutcome bei epilepsiechirurgischer Therapie. Z Epileptologie. 2007 im Druck.
• 50 Schulze-Bonhage A. SUDEP bei epilepsiechirurgisch behandelten Patienten. Z Epileptol 2006; 19: 77-83.
• 51 Schwartz TH, Jeha L, Tanner A, Bingaman W, Sperling M. Late seizures in patients initially seizure free after epilepsy surgery. Epilepsia 2006; 47: 567-573.
• 52 Semah F, Picot MC, Adam C, Broglin D, Arzimanoglou A, Bazin B, Cavalcanti D, Baulac M. Is the underlying cause of epilepsy a major prognostic factor for recurrence?. Neurology 1998; 51: 1256-1262.
• 53 Specht U, Thorbecke R. Short term inpatient rehabilitation unit. In: Pfäfflin M, Fraser RT, Thorbecke R, Specht U, Wolf P. (Hrsg) Comprehensive care for people with epilepsy. London: John Libbey& Company Ltd; 2001: 213-220.
• 54 Taylor DC, McMAckin D, Staunton H, Delanty N, Phillips J. Patients´ aims for epilepsy surgery: desires beyong seizure freedom. Epilepsia 2001; 42: 629-633.
• 55 Tellez-Zenteno JF, Dhar R, Hernandez-Ronquillo L, Wiebe S. Long-term outcomes in epilepsy surgery: antiepileptic drugs, mortality, cognitive and psychosocial aspects. Brain 2007; 130: 334-345.
• 56 Tonini C, Beghi E, Berg AT, Bogliun G, Giordano L, Newton RW, Tetto A, Vitelli E, Vitezic D, Wiebe S. Predictors of epilepsy surgery outcome: a meta-analysis. Epilepsy Res 2004; 62: 75-87.
• 57 Trevathan E, Gilliam F. Lost years: delayed referral for surgically treatable epilepsy. Neurology 2003; 61: 432-433.
• 58 Vickrey BG, Hays RD, Engel Jr J, Spritzer K, Rogers WH, Rausch R, Graber J, Brook RH. Outcome assessment for epilepsy surgery: the impact of measuring health-related quality of life. Ann Neurol 1995; 37: 158-166.
• 59 von Lehe M, Lutz M, Kral T, Schramm J, Elger CE, Clusmann H. Correlation of health-related quality of life after surgery for mesial temporal lobe epilepsy with two seizure outcome scales. Epil Behav 2006; 09: 73-82.
• 60 Wiebe S, Blume WT, Girvin JP, Eliasziw M. Effectiveness and Efficiency of Surgery for Temporal Lobe Epilepsy Study Group. A randomized, controlled trial of surgery for temporal-lobe epilepsy. N Engl J Med 2001; 345: 311-318.
• 61 Wieser HG, Ortega M, Friedman A, Yonekawa Y. Long-term seizure outcomes following amygdalohippocampectomy. J Neurosurg 2003; 98: 751-763.
• 62 Wilson SJ, Bladin PF, Salig MM, Pattison PE. Characterizing psychosocial outcome trajectories following seizure surgery. Epil Behav 2005; 06: 570-580.
• 63 Wrench J, Wilson SJ, Bladin PF. Mood disturbance before and after seizure surgery: a comparison of temporal and extratemporal resections. Epilepsia 2004; 45: 534-543.
• 64 Zentner J, Hufnagel A, Ostertun B, Wolf HK, Behrens E, Campos M, Solymosi L, Elger CE, Wiestler OD, Schramm J. Surgical treatment of extratemporal epilepsy: clinical, radiologic, and histopathologic findings in 60 patients. Epilepsia 1996; 37: 1072-1080.