成人てんかん外科の現況

Current Status of Epilepsy Surgery in Adults

てんかんの治療法は進歩し続けているものの，全患者が薬物治療で良好なコントロールを得られるわけではない。てんかん外科手術は発作を消失もしくは著明に減少させる有力な治療選択肢であるが，いまだ十分に普及しているとは言えず，さらなる環境の整備が必要である。一方で外科手術はあくまで難治てんかん治療の一部であり，てんかん患者が抱える精神的，心理・社会的側面のケアや，外部への啓発活動も重要な課題である。

Abstract

Epilepsy surgery is an effective way to control seizures in patients with refractory epilepsy, even in patients in whom drug therapy has not resulted in adequate seizure control. Many studies support the efficacy and safety of resective and non-resective surgeries for the treatment of refractory epilepsy in appropriately selected individuals. However, it is sometimes argued that epilepsy surgery is underutilized despite the evidence and guidelines supporting its use. Among the causes cited for underutilization of this treatment are numerous barriers to epilepsy surgery. Further strategies are needed to increase access to surgery and to improve communication about the effectiveness of this potentially life-changing procedure. In addition, epilepsy surgery is only one part of the multimodal treatment of refractory epilepsy. A comprehensive approach is required to address the medical, surgical, psychosocial, rehabilitation and moral needs of patients with epilepsy in order to improve their quality of life.