Dirençli epilepsili çocuklarda ilaç dışı tedavinin etkinliği

Yıl 2019, Cilt: 17 Sayı: 2, 243 - 252, 02.08.2019

Özge Vural , Ayse Serdaroglu Aysegul Nese Citak Kurt Tuğba Hirfanoğlu , Gökhan Kurt

Öz

GİRİŞ ve AMAÇ: Epilepsi en yaygın kronik, nörolojik bozukluklardan
biridir. Halen epilepsi tedavisinde eski ve yeni çok çeşitli antiepileptik ilaç
kullanılmaktadır. Bu antiepileptik ilaçların kullanımına rağmen hastaların
yaklaşık %20-30’u başarılı bir şekilde tedavi edilemez. Bu hasta grubuna ilaca
dirençli epilepsi hastaları denir. Dirençli epilepsi hastalarında nöbetlerin
sıklığı hastanın yaşam kalitesini ve bilişsel fonksiyonlarını olumsuz etkiler.
Günümüzde epilepsi cerrahisi uygulamaları ile başarılı sonuçlar elde
edilmektedir. Bu çalışmanın amacı; dirençli epilepsili çocuklarda epilepsi
cerrahisinin (rezektif/vagal sinir stimülasyonu) etkinliğini değerlendirmekti.

YÖNTEM ve GEREÇLER: Gazi Üniversitesi Tıp Fakültesi Çocuk Nöroloji Bilim Dalı
Uzun Süreli Video EEG Monitorizasyon Ünitesinde epilepsi tanısı ile izlenen ve
epilepsi cerrahi konseyi kararına göre epilepsi cerrahisi uygulanan 62 çocuk
hastanın özellikleri incelendi.

BULGULAR: Hastalardan 48’ine vagal sinir stimülasyonu (VSS), 14’üne rezektif
cerrahi uygulandı, 31’i kız, 31’i erkek ve nöbet başlangıç yaşı 35,2 +
37,0 ay, cerrahi uygulanma yaşı 11,9 + 3,8 yaş, cerrahi öncesi izlem
süresi 8,7 + 4,1 yıl idi. Rezektif cerrahi uygulanan hastalardan 12’si
halen nöbetsiz iken, vagal sinir stimülasyonu yapılan hastalardan 3’ü nöbetsiz,
1 hastada %90’dan fazla, 7 hastada %75’den fazla, 19 hastada %50’den fazla
nöbet kontrolü sağlanmıştır.

TARTIŞMA ve SONUÇ: Sonuç olarak; gerek rezektif cerrahi gerekse VSS ilaca
dirençli epilepsisi olan çocuk hastalarda uygulanan etkili tedavi
yöntemleridir. VSS görece güvenli ve hafif yan etkileri olan bir yöntemdir.
Erken dönemde, uygun hastalara uygulanan rezektif epilepsi cerrahisinin
mortaliteyi azalttığı görülmüştür. Epilepsi hastalarında uygun cerrahi yöntem
ve uygun hasta seçimi ile nöbet kontrolü büyük ölçüde sağlanabilmektedir. Uzun
dönem izlenen seriler bize bu tedavi yöntemlerinin etkinliğini ve avantajlarını
daha iyi gösterecektir. Daha etkili yöntemler bulunana kadar VSS ve rezektif
cerrahi, ilaca dirençli epilepsi hastalarında cazip tedavi yöntemleri olmaya
devam edecektir.

Anahtar Kelimeler

Epilepsi, epilepsi cerrahisi, vagal sinir stimülasyonu

The efficacy of nonpharmacologic treatment in children with pharmacoresistant epilepsy

Öz

INTRODUCTION: Epilepsy is one of the most common chronic
neurological disorders. Currently, a variety of older and newer AEDs are used
in the treatment of epilepsy. Despite the use of these AEDs, about 20-30% of
patients are not succesfully treated. This group of patients is called
pharmacoresistant epilepsy patients. The frequency of seizures in patients with
refractory epilepsy, adversely affects the quality of life and cognitive
functions. Today, successful results are obtained from the epilepsy surgery.
The purpose of this study was to evaluate the efficacy of epilepsy surgery
(resective/VNS) in children with pharmacoresistant epilepsy.

METHODS: This study was conducted among 62 children that were followed in Gazi
University department of neurology long-term video EEG monitorization unit,
with the diagnosis of epilepsy. They underwent the epilepsy surgery with the
decision of the epilepsy surgery council.

RESULTS: The study included 48 patients that underwent VNS treatment and 14 patients
that underwent resective surgery. 31 patient were girls, 31 patients were boys,
age at onset of seizures (range) was 35,2 + 37,0 months, age at epilepsy
surgery was 11,9 + 3,8 years, time before epilepsy surgery was 8,7 +
4,1 years. 12 patients that underwent resective surgery were seizure free, 3
patients with VNS implantation were seizure free after surgery. Seizure
reduction > %90 was achieved in 1 patient, > % 75 in 7 patients and >
% 50 in 19 patients.

DISCUSSION AND CONCLUSION: In conclusion resective surgery and VNS are
effective treatment methods in children with pharmacoresistant epilepsy. VNS is
relatively safe. In early period, resective epilepsy surgery for appropriate
patients reduces the mortality. With appropriate patient and appropriate
surgical method selection in patients with epilepsy, seizure control can be
achieved largely. Until more effective therapies are developed, VNS and
resective surgery will remain attractive alternatives for pharmacoresistant
epilepsy. 

Anahtar Kelimeler

Epilepsy, epilepsy surgery

Kaynakça

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