てんかん痙攣発作に対するForel-H—tomyの臨床成績

CLINICAL RESULTS OF THE FOREL-H-TOMY FOR THE TREATMENT OF THE EPILEPSY

I．緒言

　てんかん痙攣発作に対する外科的療法として，症候性てんかんでは焦点それ自体をとりさることが当然とされているが，それが神経学的に重要な場所で，手術的に切除困難な場合とか，または焦点の不明な真性てんかんの場合には，痙攣伝導路遮断のため，あるいは賦活系からの上行性経路の遮断のため，さらにまた脳幹部での焦点破壊の目的で，脳幹の高さでの定位的手術が試みられてきている^{3）4）9）10）12）14）15）}。

　そのうち，Forel-H野の破壊術は，昭和34年以来陣内およびその門下によつて動物実験^1）5）の結果に基づいててんかん痙攣伝導路の遮断術として臨床的に応用され，すでにその成績について発表した^3）4）。

Nine epileptics, idiopathic or symptomatic were stereotaxically operated on Forel-H-tomy by means of electrical coagulation or liquid nitrogen freezing method. The postoperative follow-up was checked from a month to 13 months in the course.

1. Alleviation of the epileptogenic convulsion was obtained at the stereotaxic surgery of the Forel-H-tomy as well as improvement of the epileptogenic character and behavior, irrespective of focal or general seizure of grand mal- or petit mal-type.

2. Improvement of the abnormal activity in EEG was noted.

3. The inhibitory effect was built up following several weeks of postoperative aggravation under the clinical observation, which corresponded with the course of the EEG improvement.

4. Transient aphasia or aphonia was resulted in some cases of the bilateral Forel-H-tomy. The stereotaxic cordinates of the lesions of these cases were all dorsal to the target point and therefore these side-elects were not due to destruction of the Forel-H field proper.

5. The Forel-H-tomy appears to be bilaterally indicative for the case of abnormal EEG activity in both hemispheres and ipsilaterally for the one of the abnormality in unilateral hemisphere.