BRAIN and NERVE－神経研究の進歩63巻4号

2011年04月発行

増大特集 てんかんの新しい治療

側頭葉てんかんの外科治療―過去からの問題点を振り返る

著者： 星田徹¹

所属機関： ¹独立行政法人国立病院機構奈良医療センター

ページ範囲：P.313 - P.320

文献概要

はじめに

　てんかんの外科治療で現在，ランダム化比較試験で有用性が確実に認められているのは，側頭葉てんかん（temporal lobe epilepsy：TLE）に対する外科手術である。てんかんの外科治療が開始されてから120年余りが経過したが，TLEの診断や外科治療がなされるようになったのは外傷性てんかんの手術に遅れること30年，1920年代後半であった。本稿では，有用性が確立しているTLEに話題を絞って，今までの足跡をFeindelら^1）の報告から振り返り，最近の手術方法とその結果は三原ら^2），Schramm^3）の報告を中心に，そして当院での長期手術結果を踏まえて，今後のTLE外科手術に向けた課題を考える。

参考文献

1) Feindel W, Leblanc R, de Almeida AN: Epilepsy surgery: historical highlights 1909-2009. Epilepsia 50: 131-151, 2009

2) 三原忠紘, 松田一巳: 第9章　側頭葉てんかんの手術. 外科てんかん学入門　脳の働きをうかがい知る. 創造出版, 東京, 2008, pp87-104

3) Schramm J: Temporal lobe epilepsy surgery and the quest for optimal extent of resection: a review. Epilepsia 49: 1296-1307, 2008

4) Mikuni N, Miyamoto S, Ikeda A, Satow T, Taki J, et al: Subtemporal hippocampectomy preserving the basal temporal language area for intractable mesial temporal lobe epilepsy: preliminary results. Epilepsia 47: 1347-1353, 2006

5) 大槻泰介, 三原忠紘, 亀山茂樹, 馬場啓至（編): 難治性てんかんの外科治療プラクティカル・ガイドブック　診断と治療社, 東京, 2007

6) Rasmussen TB: Surgical treatment of complex partial seizures: results, lessons, and problems. Epilepsia 24: S56-S75, 1983

7) Foldvary N, Nashold B, Mascha E, Thompson EA, Lee N, et al: Seizure outcome after temporal lobectomy for temporal lobe epilepsy: a Kaplan-Meier survival analysis. Neurology 54: 630-634, 2000

8) Schiller Y, Cascino GD, So EL, Marsh WR: Discontinuation of antiepileptic drugs after successful epilepsy surgery. Neurology 54: 346-349, 2000

9) Wiebe S, Blume WT, Girvin JP, Eliasziw M: A randomized, controlled trial of surgery for temporal-lobe epilepsy. N Engl J Med 345: 311-318, 2001

10) Salanova V, Markand O, Worth R: Temporal lobe epilepsy surgery: outcome, complications, and late mortality rate in 215 patients. Epilepsia 43: 170-174, 2002

11) Yoon HH, Kwon HL, Mattson RH, Spencer DD, Spencer SS: Long-term seizure outcome in patients initially seizure-free after resective epilepsy surgery. Neurology 61: 445-450, 2003

12) McIntosh AM, Kalnins RM, Mitchell LA, Fabinyi GC, Briellmann RS, et al: Temporal lobectomy: long-term seizure outcome, late recurrence and risks for seizure recurrence. Brain 127: 2018-2030, 2004

13) Tellez-Zenteno JF, Dhar R, Wiebe S: Long-term seizure outcomes following epilepsy surgery: a systematic review and meta-analysis. Brain 128: 1188-1198, 2005

14) Kelley K, Theodore WH: Prognosis 30 years after temporal lobectomy. Neurology 64: 1974-1976, 2005

15) Cohen-Gadol AA, Wilhelmi BG, Collignon F, White JB, Britton JW, et al: Long-term outcome of epilepsy surgery among 399 patients with nonlesional seizure foci including mesial temporal lobe sclerosis. J Neurosurg 104: 513-524, 2006

16) Asztely F, Ekstedt G, Rydenhag B, Malmgren K: Long term follow-up of the first 70 operated adults in the Goteborg Epilepsy Surgery Series with respect to seizures, psychosocial outcome and use of antiepileptic drugs. J Neurol Neurosurg Psychiatry 78: 605-609, 2007

17) Baxendale S, Thompson P: Defining meaningful postoperative change in epilepsy surgery patients: measuring the unmeasurable? Epilepsy Behav 6: 207-211, 2005

18) Engman E, Andersson-Roswall L, Samuelsson H, Malmgren K: Serial cognitive change patterns across time after temporal lobe resection for epilepsy. Epilepsy Behav 8: 765-772, 2006

19) Alpherts WCJ, Vermeulen J, van Rijen PC, Lopes da Silva FH, van Veelen CWM: Verbal memory decline after temporal epilepsy surgery? A 6-year multiple assessments follow-up study. Neurology 67: 626-631, 2006

20) Tellez-Zenteno JF, Dhar R, Hernandez-Ronquillo L, Wiebe S: Long-term outcomes in epilepsy surgery: antiepileptic drugs, mortality, cognitive and psychosocial aspects. Brain 130: 334-345, 2007

21) Langfitt JT, Westerveld M, Hamberger MJ, Walczak TS, Cicchetti DV, et al: Worsening of quality of life after epilepsy surgery: Effect of seizures and memory decline. Neurology 68: 1988-1994, 2007

22) Andersson-Roswall L, Engman E, Samuelsson H, Malmgren K: Cognitive outcome 10 years after temporal lobe epilepsy surgery. a prospective controlled study. Neurology 74: 1977-1985, 2010

23) Wilson SJ, Saling MM, Kincade P, Bladin PF: Patient expectations of temporal lobe surgery. Epilepsia 39: 167-174, 1998

24) Wilson S, Bladin P, Saling M: The "burden of normality": concepts of adjustment after surgery for seizures. J Neurol Neurosurg Psychiatry 70: 649-656, 2001

25) Seaburn DB, Erba G: The family experience of "sudden health": the case of intractable epilepsy. Fam Process 42; 453-467, 2003

26) Meldolesi GN, Di Gennaro G, Quarato PP, Esposito V, Grammaldo LG, et al: Changes in depression, anxiety, anger, and personality after resective surgery for drug-resistant temporal lobe epilepsy: a 2-year follow-up study. Epilepsy Res 77: 22-30, 2007

27) Baxendale S: The impact of epilepsy surgery on cognition and behavior. Epilepsy Behav 12: 592-599, 2008

28) Shimizu H, Kawai K, Sunaga S, Sugano H, Yamada T: Hippocampal transection for treatment of left temporal lobe epilepsy with preservation of verbal memory. J Clin Neurosci 13: 322-328, 2006

29) Powell HW, Richardson MP, Symms MR, Boulby PA, Thompson PJ, et al: Reorganization of verbal and nonverbal memory in temporal lobe epilepsy due to unilateral hippocampal sclerosis. Epilepsia 48: 1512-1525, 2007

30) 星田　徹: てんかんと画像診断―てんかんのFocusをどのように決めるか―, 小児神経学の進歩　第35集（山野恒一: 編), 診断と治療社, 東京, 2006, pp40-63