Çocukluk Çağı Epilepsi Cerrahisi ve Nöromodülasyon
Özet
Çocuklarda epilepsi, beynin gelişimi üzerindeki olumsuz etkileri nedeniyle erken teşhis ve tedavi gerektiren ciddi bir sağlık sorunudur. İlaç tedavisine dirençli vakalarda, epileptik odakların belirlenerek cerrahi yöntemlerle çıkarılması veya deşarjların yayılımının engellenmesi, hastaların yaşam kalitesini ve bilişsel fonksiyonlarını önemli ölçüde iyileştirebilmektedir. Cerrahiye uygun hastaların belirlenmesi için detaylı nörogörüntüleme ve nöropsikiyatrik değerlendirmeler şarttır. Geleneksel rezeksiyon cerrahilerinin yanı sıra vagus sinir stimülasyonu ve derin beyin stimülasyonu gibi nöromodulasyon teknikleri, cerrahiye aday olmayan hastalar için alternatif ve etkili tedavi seçenekleri sunmaktadır.
Childhood epilepsy requires early detection and treatment to prevent long-term functional and cognitive damage, especially in drug-resistant cases. When medication fails, surgical interventions—including resection or disconnection procedures—are essential to either cure or manage seizures by targeting the specific epileptic zone. Comprehensive pre-surgical evaluations, such as advanced neuroimaging, are critical to determine candidacy and ensure optimal outcomes. Additionally, neuromodulation techniques like vagus nerve stimulation and deep brain stimulation provide effective alternatives for patients who are not suitable candidates for traditional resection surgery.
Referanslar
Franzon, Renata & Guerreiro, Marilisa. (2006). Temporal lobe epilepsy in childhood: Review article. Journal of Epilepsy and Clinical Neurophysiology. 12. 10.1590/S1676-26492006000200006.
R. Jonas, S. Nguyen, B. Hu, R. F. Asarnow, C. LoPresti, S. Curtiss, S. de Bode, S. Yudovin, W. D. Shields, H. V. Vinters, G. W. Mathern Neurology May 2004, 62 (10) 17121721; DOI: 10.1212/01.WNL.0000127109.14569.C3
Thompson P.J., Duncan J.S.: Cognitive decline in severe intractable epilepsy. Epilepsia 2005; 46: pp. 1780-1787.
Löscher W, Potschka H, Sisodiya SM, Vezzani A. Drug Resistance in Epilepsy: Clinical Impact, Potential Mechanisms, and New Innovative Treatment Options. Pharmacol Rev. 2020;72(3):606-638. doi:10.1124/pr.120.019539
Gadgil N, LoPresti MA, Muir M, et al. An update on pediatric surgical epilepsy: Part I. Surg Neurol Int. 2019;10:257. Published 2019 Dec 27. doi:10.25259/SNI_417_2019
Chaturbhuj Rathore, Kurupath Radhakrishnan. Concept of epilepsy surgery and presurgical evaluation. Epileptic Disorders. 2015;17(1):19-31. doi:10.1684/epd.2014.0720
Felix Rosenow, Hans Lüders, Presurgical evaluation of epilepsy, Brain, Volume 124, Issue 9, September 2001, Pages 1683–1700
Ryvlin P, Cross JH, Rheims S: Epilepsy surgery in children and adults. Lancet Neurol. 2014;13(11):1114–26. 10.1016/S1474-4422(14)70156-5
P Jayakar, WD Gaillard, M Tripathi, MH Libenson, GW Mathern, JH Cross Diagnostic test utilization in evaluation for resective epilepsy surgery in children Epilepsia, 55 (2014), pp. 507-518
Duncan JS, Winston GP, Koepp MJ, Ourselin S. Brain imaging in the assessment for epilepsy surgery. Lancet Neurol. 2016;15(4):420-433. doi:10.1016/S1474-4422(15)00383-X
Characteristics and surgical outcomes of patients with refractory magnetic resonance imaging-negative epilepsies.Bien CG, Szinay M, Wagner J, Clusmann H, Becker AJ, Urbach HArch Neurol. 2009 Dec; 66(12):1491-9.
Grünwald F, Hufnagel A, Elger CE, Biersack HJ. Single-Photon-Emissions-computertomographie (SPECT) in der Epilepsiediagnostik [Single-photon, emission-computed tomography (SPECT) in the diagnosis of epilepsy]. Radiologe. 1993 Apr;33(4):198-203. German. PMID: 8506408.
Ryvlin P, Cross JH, Rheims S. Epilepsy surgery in children and adults. Lancet Neurol. 2014 Nov;13(11):1114-1126. doi: 10.1016/S1474-4422(14)70156-5. PMID: 25316018
Jeyaraj M.K., Menon R.N., Justus S., Alexander A., Sarma P.S., Radhakrishnan K. A critical evauation of the lateralizing significance of material-specific memory deficits in patients with mesial temporal lobe epilepsy with hippocampal sclerosis. Epilepsy Behav. 2013;28:460-466.
Tomycz, Luke D MD,; Hale, Andrew T MS; Haider, Ali S BS; Clarke, Dave F MD, MBBS; Lee, Mark R MD, PhD Invasive Insular Sampling in Pediatric Epilepsy: A Single-Institution Experience, Operative Neurosurgery: September 2018 - Volume 15 - Issue 3 - p 310-317 doi: 10.1093/ons/opx253
Luis E. Bello-Espinosa MD and Greg Olavarria MDPediatric Clinics of North America, 2021-08-01, Volume 68, Issue 4, Pages 845-856
Benifla M, Otsubo H, Ochi A, Weiss SK, Donner EJ, Shroff M, Chuang S, Hawkins C, Drake JM, Elliott I, Smith ML, Snead OC 3rd, Rutka JT. Temporal lobe surgery for intractable epilepsy in children: an analysis of outcomes in 126 children. Neurosurgery. 2006 Dec;59(6):1203-13; discussion 1213-4. doi: 10.1227/01.NEU.0000245615.32226.83. PMID: 17277683.
Spencer S, Huh L. Outcomes of epilepsy surgery in adults and children. Lancet Neurol. 2008 Jun;7(6):525-37. doi: 10.1016/S1474-4422(08)70109-1. PMID: 18485316
Sean M. Lew, MD, Jennifer I. Koop, PhD, Wade M. Mueller, MD, Anne E. Matthews, PA-C, Julianne C. Mallonee, BSN, Fifty Consecutive Hemispherectomies: Outcomes, Evolution of Technique, Complications, and Lessons Learned, Neurosurgery, Volume 74, Issue 2, February 2014, Pages 182–195
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 Aug 2;345(5):311-8. doi: 10.1056/NEJM200108023450501. PMID: 11484687.
Akalan N, Bilginer B. Pediatric temporal lobe epilepsy surgery: resection based on etiology and anatomical location. Adv Tech Stand Neurosurg. 2012;39:87-116. doi: 10.1007/978-3-7091-1360-8_4. PMID: 23250838.
CE Marras, T Granata, A Franzini, et al.Hemispherotomy and functional hemispherectomy: Indications and outcome Epilepsy Res, 89 (2010), pp. 104-112 )
Lew SM. Hemispherectomy in the treatment of seizures: a review. Transl Pediatr. 2014;3(3):208-217. doi:10.3978/j.issn.2224-4336.2014.04.01
Matern TS, DeCarlo R, Ciliberto MA, Singh RK. Palliative Epilepsy Surgery Procedures in Children. Semin Pediatr Neurol. 2021 Oct;39:100912. doi: 10.1016/j.spen.2021.100912. Epub 2021 Aug 19. PMID: 34620461.
Smyth MD, Vellimana AK, Asano E, Sood S. Corpus callosotomy-Open and endoscopic surgical techniques. Epilepsia. 2017 Apr;58 Suppl 1:73-79. doi: 10.1111/epi.13681. PMID: 28386923
Lew SM, Koop JI, Mueller WM, Matthews AE, Mallonee JC. Fifty consecutive hemispherectomies: outcomes, evolution of technique, complications, and lessons learned. Neurosurgery. 2014;74(2):182-195. doi:10.1227/NEU.0000000000000241
Terra-Bustamante, V.C., Inuzuka, L.M., Fernandes, R.M.F. et al. Outcome of hemispheric surgeries for refractory epilepsy in pediatric patients. Childs Nerv Syst 23, 321–326 (2007).
Schramm, J., Kuczaty, S., Sassen, R. et al. Pediatric functional hemispherectomy: outcome in 92 patients. Acta Neurochir 154, 2017–2028 (2012). https://doi.org/10.1007/s00701-012-1481-3
D Graham, MM Tisdall, D. Gill Corpus callosotomy outcomes in pediatric patients: A systematic review Epilepsia, 57 (2016), pp. 1053-1068
Matern TS, DeCarlo R, Ciliberto MA, Singh RK. Palliative Epilepsy Surgery Procedures in Children. Semin Pediatr Neurol. 2021 Oct;39:100912. doi: 10.1016/j.spen.2021.100912. Epub 2021 Aug 19. PMID: 34620461.
Duncan JS. Epilepsy surgery. Clin Med (Lond). 2007 Apr;7(2):137-42. doi:10.7861/clinmedicine.7-2-137. PMID: 17491501; PMCID: PMC4951827.
Asadi-Pooya AA, Sharan A, Nei M, Sperling MR. Corpus callosotomy. Epilepsy Behav. 2008 Aug;13(2):271-8. doi: 10.1016/j.yebeh.2008.04.020. Epub 2008 Jun 6. PMID: 18539083.
Wong, TT., Kwan, SY., Chang, KP. et al. Corpus callosotomy in children. Childs Nerv Syst 22, 999–1011 (2006). https://doi.org/10.1007/s00381-006-0133-4
North R.Y., Raskin J.S., Curry D.J.: MRI-guided laser interstitial thermal therapy for epilepsy. Neurosurg Clin North Am 2017; 28: pp. 545-557.
Shah R, Botre A, Udani V. Trends in pediatric epilepsy surgery. Indian J Pediatr. 2015 Mar;82(3):277-85. doi: 10.1007/s12098-014-1660-8. Epub 2015 Feb 4. PMID: 25646596.
Rolston JD, Deng H, Wang DD, Englot DJ, Chang EF. Multiple Subpial Transections for Medically Refractory Epilepsy: A Disaggregated Review of Patient-Level Data. Neurosurgery. 2018;82(5):613-620. doi:10.1093/neuros/nyx311
Elliott RE, Rodgers SD, Bassani L, Morsi A, Geller EB, Carlson C, Devinsky O, Doyle WK. Vagus nerve stimulation for children with treatment-resistant epilepsy: a consecutive series of 141 cases. J Neurosurg Pediatr. 2011 May;7(5):491-500. doi: 10.3171/2011.2.PEDS10505. PMID: 21529189.
Drane DL. MRI-Guided stereotactic laser ablation for epilepsy surgery: Promising preliminary results for cognitive outcome. Epilepsy Res. 2018 May;142:170-175. doi: 10.1016/j.eplepsyres.2017.09.016. Epub 2017 Sep 23. PMID: 28964596; PMCID: PMC5866159
Hoppe C, Helmstaedter C. Laser interstitial thermotherapy (LiTT) in pediatric epilepsy surgery. Seizure. 2020 Apr;77:69-75. doi: 10.1016/j.seizure.2018.12.010. Epub 2018 Dec 18. PMID: 30591281.
Beekwilder, J. P.*†‡; Beems, T.*‡ Overview of the Clinical Applications of Vagus Nerve Stimulation, Journal of Clinical Neurophysiology: April 2010 - Volume 27 - Issue 2 - p 130-138doi: 10.1097/WNP.0b013e3181d64d8a
Thompson EM, Wozniak SE, Roberts CM, Kao A, Anderson VC, Selden NR. Vagus nerve stimulation for partial and generalized epilepsy from infancy to adolescence. J Neurosurg Pediatr. 2012 Sep;10(3):200-5. doi: 10.3171/2012.5.PEDS11489. Epub 2012 Jul 6. PMID: 22768964.
Ellrich, Jens * Transkütan Auriküler Vagus Sinir Stimülasyonu, Klinik Nörofizyoloji Dergisi: Kasım 2019 - Cilt 36 - Sayı 6 - s 437-442 doi: 10.1097 / WNP.0000000000000576
Stefan H, Kreiselmeyer G, Kerling F, et al. Transcutaneous vagus nerve stimulation (t-VNS) in pharmacoresistant epilepsies: a proof of concept trial. Epilepsia 2012;53:e115–e118
Yan H, Toyota E, Anderson M, Abel TJ, Donner E, Kalia SK, Drake J, Rutka JT, Ibrahim GM. A systematic review of deep brain stimulation for the treatment of drug-resistant epilepsy in childhood. J Neurosurg Pediatr. 2018 Nov 30;23(3):274-284. doi: 10.3171/2018.9.PEDS18417. PMID: 30544364.
Klinkenberg S, Aalbers MW, Vles JS, Cornips EM, Rijkers K, Leenen L, Kessels FG, Aldenkamp AP, Majoie M. Vagus nerve stimulation in children with intractable epilepsy: a randomized controlled trial. Dev Med Child Neurol. 2012 Sep;54(9):855-61. doi: 10.1111/j.1469-8749.2012.04305.x. Epub 2012 Apr 28. PMID: 22540141.
Oliveira TVHF, Francisco AN, Demartini Z Junior, Stebel SL. The role of vagus nerve stimulation in refractory epilepsy. Arq Neuropsiquiatr. 2017 Sep;75(9):657-666. doi: 10.1590/0004-282X20170113. PMID: 28977147.
Fisher R, Salanova V, Witt T, et al. Electrical stimulation of the anterior nucleus of thalamus for treatment of refractory epilepsy. Epilepsia 2010;51:899–908.
