てんかんに対する外科的アプローチ

Surgical Treatment for Epilepsy: An Updated Summary of Treatment Modalities and Clinical Evidence

てんかんに対する外科的治療は，特に薬剤抵抗性てんかんにおいてその有効性を支持するエビデンスが確立している。近年は検査手法の進歩や治療モダリティの増加により，欧米を中心に治療選択肢も増えてきた。これらの一部は本邦未導入であるが，てんかんに対する外科治療の恩恵を享受する患者が1人でも増えることを念頭に，現状のてんかん外科治療の選択肢の概要とこれまで蓄積しているエビデンスを整理しアップデートする。

Abstract

The efficacy of surgical treatment for drug-resistant epilepsy has been proven based on accumulated evidence, such as several randomized controlled trials. There are emerging treatment modalities, including less invasive surgical techniques and neuromodulation devices, which have also been proven to benefit patients by improving seizure control. A recent methodological shift from subdural electrocorticography recordings to stereo-encephalography recordings for intracranialelectroencephalography (iEEG) monitoring has also positively impacted clinical decision-making. Although some of these newer modalities are yet to be implemented in Japan, this article provides updated evidence and a summary of the currently available options for surgical treatment of patients with drug-resistant epilepsy. We hope that this summary will widen the treatment opportunities for patients with this highly impactful disease.