難治性てんかんとその対応

Diagnosis of Drug-Resistant Epilepsy and Actions to be Taken

2種類以上の抗てんかん薬（抗発作薬）を十分に用いてもてんかん発作が1年以上抑制されないときは薬剤抵抗性てんかんと判断し，てんかんセンターへの連携を検討する。てんかんセンターの重要な診療機能には長時間ビデオ脳波モニタリングとてんかん外科があり，てんかん診断の見直しや外科適応の検討が行われる。わが国は，人口あたりのてんかん外科実施件数が米国の約40％にとどまっており，てんかんの診療連携推進が望まれる。

Abstract

Drug-resistant epilepsy is defined when epileptic seizures are not controlled for over a year despite adequate use of two or more anti-epileptic drugs. Patients with drug-resistant epilepsy should be referred to a specialized epilepsy center without delay. The epilepsy centers provide long-term video-EEG monitoring and epilepsy surgery as essential medical functions. The diagnosis and treatment of epilepsy are reviewed through an interdisciplinary care team approach. A surgical indication is discussed and determined after a comprehensive evaluation of patients with drug-resistant epilepsy. The number of epilepsy surgeries performed per population in Japan is approximately 40% of that in the United States. However, the number of epilepsy centers and the number of video-EEGs performed remain low. It is expected to facilitate patients' access to specialized care in Japan.