神经外科患者癫痫反复发作处理分析

Perioperative management of neurosurgical patients with recurrent epileptic seizures

目的探讨神经外科患者出现癫痫反复发作的临床特点、处理原则与方法。方法回顾性分析沈阳军区总医院神经外科自2011年1月至6月收治的9例癫痫反复发作患者的临床资料，分析其加重的原因、发作特点及治疗方法和结果。结果9例患者中3例合并胶质瘤、1例蛛网膜囊肿、1例海绵状血管瘤、1例脑软化灶；7例有癫痫病史，2例既往无癫痫病史；7例为额叶癫痫，2例颞叶癫痫。癫痫发作加重的原因：减药3例，新诊断的脑肿瘤2例，手术f颅内电极置入术11例，原因不明3例。癫痫发作类型包括部分性发作与全面性发作，发作频率从间隔3min至间隔数小时发作一次。患者经给予多种抗癫痫药物联合用药治疗，包括口服与注射给药，癫痫得到控制．其中添加左乙拉西坦口服有较好的疗效。结论神经外科患者出现癫痫反复发作多呈药物难治性，发作不易控制，其处理应使用对部分性癫痫发作有较好疗效的多种抗癫痫药物联合用药，剂量应高于常规初始剂量，包括静脉注射及肌注给药，以尽快控制癫痫发作。左乙拉西坦因口服吸收快、起效迅速及有较好的抗癫痫作用，对癫痫反复发作有较好的疗效。

Objective To investigate the clinical features of recurrent epileptic seizures and perioperative management principles and methods of neurosurgical patients with recurrent epileptic seizures. Methods The clinical data, reasons for aggravated seizures, seizure characteristics, and treatment methods and results of 9 patients with recurrent epileptic seizures were analyzed retrospectively. Results Of all the 9 patients, 3 were combined with glioma, 1 with arachnoid cyst, 1 with cavernous hemangioma and 1 with encephalomalacia; epilepsy history was noted in 7 patients; frontal lobe epilepsy was noted in 7, and temporal lobe epilepsy in 2. The reasons for seizure aggravation included drug-decrement （n=3）, recent-diagnosed brain tumor （n=2） and surgical operation during intracranial electrode implantation （n=l）; and unknown reason was noted in the other 3. Epileptic seizure types included partial seizure and secondary generalized seizure; the frequency of seizure ranged from 3 minutes of interval to several hours of interval. Patients given multiple antiepileptic drugs, including oral and parenteral administration, received good seizure-control; and levetiracetam showed good curative effect during the treatment. Conclusion Recurrent seizures show drug refractory, and is hard to control. The AEDs having good curative effect in partial seizure should be combined used in these patients with higher dosage than conventional initial dose; intravenous and intramuscular administration can be used; the seizures should be controlled as soon as posible. Levetiracetam has good curative effect on patients with recurrent seizures for its fast oral-absorption, rapid onset of action and good antiepileptic effect.