Background: The effect of Vagus nerve stimulation (VNS) therapy following major resective surgeries has been reported. However, the effect of VNS therapy following multiple-subpial-transections (MST) has not been repo...Background: The effect of Vagus nerve stimulation (VNS) therapy following major resective surgeries has been reported. However, the effect of VNS therapy following multiple-subpial-transections (MST) has not been reported. The objective of this paper is to examine the beneficial effect of VNS therapy following MST. Methods: There are 22 patients aged 10 - 55 years. Male/female distribution is 11/11 and follow-up is 24 - 148 months (median of 120 months). Seizure foci were bilateral in 9 patients, multi-lobar (unilateral) in 12 patients and single-lobar in 1 patient. MST was performed over broad areas in and around the seizure foci. VNS implantation was done when the response to MST procedure was poor (1 patients), or there was recurrence of seizures (21 patients). Interval between MST and VNS implanttation varied from one month to three years (median of 2 years). Results: Thirteen patients (59%) are seizure free (Engel’ Class I), 8 (36.5%) have greater than 90% reduction in seizure frequency (Class II), and 1 (4.5%) has between 50% - 90% reduction in seizure frequency (Class III). Conclusion: The results show that VNS therapy produced meaningful improvement in seizure outcome in all patients with extra-temporal seizures that had inadequate response to MST.展开更多
Objective Multiple subpial transection (MST) is one approach to the surgical treatment of intractable epilepsy with epileptogenic lesion located in functional areas To verify the effect of MST, an experiment...Objective Multiple subpial transection (MST) is one approach to the surgical treatment of intractable epilepsy with epileptogenic lesion located in functional areas To verify the effect of MST, an experimental study was performed first, followed by clinical application Methods On the basis of the experimental study, MST was performed in 200 intractable epileptic patients from 1991 to 2000 Of them, 80 cases underwent MST only while 120 others underwent MST combined with other techniques, such as corpus callosotomy, temporal lobectomy and focus resection A series of modifications of the surgical techniques were made Results The results of the experimental study indicated that MST could inhibit the formation and spreading of epileptic discharge and limit the damage to neurons in a minimal area on the epileptogenic agent injected cortex MST does not impair major functions of the cortex After the clinical application and modifications, 160 patients were followed up for 1 to 8 years Complete control of seizure was obtained in 100 cases (62 5%), significant reduction (more than 75%) in 32, reduction (more than 50%) in 20 and no change in 8 The total rate of effectiveness was 95 0%, and the significant rate of effectiveness was 82 5% No functional defects were found in any patients Conclusions The results indicate that MST is an effective approach to the surgical treatment of intractable epilepsy MST can be combined with other approaches The outcome of the subdivision of the MST only group indicates that MST on local epileptogenic lesion without structural changes is as effective as that of the combined operation group To evade hemispheric disturbance, MST should be done first to avoid severe complications Hemispherectomy should be performed only on poor effected cases of MST展开更多
On the basis of experimental study, we applied multiple subpial transection (MST) to treat 50 patients with intractable epilepsy in which epileptigenic lesion involved functional areas such as pericentral gyms, postce...On the basis of experimental study, we applied multiple subpial transection (MST) to treat 50 patients with intractable epilepsy in which epileptigenic lesion involved functional areas such as pericentral gyms, postcentral gyrus, Broca's area, Wernicke's area, visual cortex, etc. They were followed up for 6 to 40 months. Complete control of seizures was obtained in 32 patients, significant reduction of seizure (more than 50%) in 13, reduction (less than 50%) in 3, and no effect in 2. The total effective rate was 96%. No functional defect was found in all patients. The mechanism of the disease and surgical technique were discussed in detail. We consider that MST could replace some standard excisional therapy for local epilepsy.展开更多
文摘Background: The effect of Vagus nerve stimulation (VNS) therapy following major resective surgeries has been reported. However, the effect of VNS therapy following multiple-subpial-transections (MST) has not been reported. The objective of this paper is to examine the beneficial effect of VNS therapy following MST. Methods: There are 22 patients aged 10 - 55 years. Male/female distribution is 11/11 and follow-up is 24 - 148 months (median of 120 months). Seizure foci were bilateral in 9 patients, multi-lobar (unilateral) in 12 patients and single-lobar in 1 patient. MST was performed over broad areas in and around the seizure foci. VNS implantation was done when the response to MST procedure was poor (1 patients), or there was recurrence of seizures (21 patients). Interval between MST and VNS implanttation varied from one month to three years (median of 2 years). Results: Thirteen patients (59%) are seizure free (Engel’ Class I), 8 (36.5%) have greater than 90% reduction in seizure frequency (Class II), and 1 (4.5%) has between 50% - 90% reduction in seizure frequency (Class III). Conclusion: The results show that VNS therapy produced meaningful improvement in seizure outcome in all patients with extra-temporal seizures that had inadequate response to MST.
文摘Objective Multiple subpial transection (MST) is one approach to the surgical treatment of intractable epilepsy with epileptogenic lesion located in functional areas To verify the effect of MST, an experimental study was performed first, followed by clinical application Methods On the basis of the experimental study, MST was performed in 200 intractable epileptic patients from 1991 to 2000 Of them, 80 cases underwent MST only while 120 others underwent MST combined with other techniques, such as corpus callosotomy, temporal lobectomy and focus resection A series of modifications of the surgical techniques were made Results The results of the experimental study indicated that MST could inhibit the formation and spreading of epileptic discharge and limit the damage to neurons in a minimal area on the epileptogenic agent injected cortex MST does not impair major functions of the cortex After the clinical application and modifications, 160 patients were followed up for 1 to 8 years Complete control of seizure was obtained in 100 cases (62 5%), significant reduction (more than 75%) in 32, reduction (more than 50%) in 20 and no change in 8 The total rate of effectiveness was 95 0%, and the significant rate of effectiveness was 82 5% No functional defects were found in any patients Conclusions The results indicate that MST is an effective approach to the surgical treatment of intractable epilepsy MST can be combined with other approaches The outcome of the subdivision of the MST only group indicates that MST on local epileptogenic lesion without structural changes is as effective as that of the combined operation group To evade hemispheric disturbance, MST should be done first to avoid severe complications Hemispherectomy should be performed only on poor effected cases of MST
文摘On the basis of experimental study, we applied multiple subpial transection (MST) to treat 50 patients with intractable epilepsy in which epileptigenic lesion involved functional areas such as pericentral gyms, postcentral gyrus, Broca's area, Wernicke's area, visual cortex, etc. They were followed up for 6 to 40 months. Complete control of seizures was obtained in 32 patients, significant reduction of seizure (more than 50%) in 13, reduction (less than 50%) in 3, and no effect in 2. The total effective rate was 96%. No functional defect was found in all patients. The mechanism of the disease and surgical technique were discussed in detail. We consider that MST could replace some standard excisional therapy for local epilepsy.
