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Ablation und Epileptogenizität – Zur Beziehung von Läsion und Funktion

Ablation and epileptogenicity – the relationship between lesion and function

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Zusammenfassung

Hintergrund und Ziel der Arbeit

In dem folgenden Artikel wird der grundsätzliche Zusammenhang bezüglich der epileptogenen Läsion einerseits und den Ergebnissen elektrophysiologischer funktioneller Untersuchungsmethoden in der prächirurgischen Diagnostik anderseits unter besonderer Berücksichtigung von ablativen epilepsiechirurgischen Methoden zusammengefasst.

Material und Methoden

Eine ausgewählte Literatursammlung wird diskutiert.

Ergebnisse

Aus der Sicht der Autoren ist eine Läsionektomie alleine kein Garant für ein erfolgreiches Ergebnis nach einem epilepsiechirurgischen Eingriff: Verschiedene epileptogene Läsionen führen zu verschiedenen epileptogenen Netzwerken, die wiederum eines differenziellen Gebrauchs von nichtinvasiven und invasiven funktionellen Untersuchungsmethoden, wie z. B. Quellenlokalisation, intraoperative Elektrokortikogramme oder Tiefenelektroden, bedürfen.

Schlussfolgerungen

Bei jedem individuellen Patienten sollte die Epileptogenizität einer Läsion unter Berücksichtigung des Läsionstyps, der Lokalisation der Läsion und deren Verhältnis zum eloquenten Kortex bestimmt werden. Die durch die MRT definierten Läsionsgrenzen sind nicht immer ausreichend, um ein gutes Langzeitergebnis bezüglich Anfangskontrolle zu bekommen. Prospektive, kontrollierte und – idealerweise – randomisierte Studien sind notwendig, um ein optimales, rational begründetes, diagnostisches und daraus folgend therapeutisches Vorgehen für die neu aufkommenden minimalinvasiven, ablativen epilepsiechirurgischen Methoden verwenden zu können.

Abstract

Background and objective

Description of the relationship between epileptogenic lesions and results from electrophysiological and functional findings during the presurgical work-up. Special consideration is given to ablative surgical techniques.

Material and methods

Synopsis of published results concerning ablation and electrophysiology.

Results

Lesionectomies alone might not lead to successful surgical results. Different lesion types lead to different epileptogenic networks, which require a differential use of non-invasive or invasive functional studies, such as source localization, intraoperative electrocorticogram and depth electrode recordings.

Conclusion

Epileptogenicity of lesions in pharmacoresistant epilepsy have to be defined individually with regard to lesion type, location and relation to eloquent cortex. Lesion borders defined by magnetic resonance imaging (MRI) are not always sufficient to achieve postoperative long-term seizure control. Prospective randomized controlled studies are necessary to establish optimized rational diagnostics and subsequent therapeutic approaches for new upcoming minimally invasive ablative surgical techniques.

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Danksagung

Frau C. Saint-Lot und Herr cand. med. A. Ilse halfen bei Fertigstellung des Manuskripts.

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Authors and Affiliations

  1. Abteilung für Neurologie und Biomagnetismus, Universitätsklinik Erlangen, Schwabach-Anlage 10, 91054, Erlangen, Deutschland

    H. Stefan

  2. Universitätsklinik für Neurologie, Otto-v.-Guericke Universität Magdeburg, Magdeburg, Deutschland

    F. C. Schmitt

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Correspondence to H. Stefan.

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H. Stefan hat DFG-Fördermittel erhalten. Zudem bekam er Reisevergütungen von Elekta Inc. und Medtronic Inc. F.C. Schmitt erhielt Zuwendungen für Reisekosten und Vortragsvorbereitungen von Medtronic Inc.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Stefan, H., Schmitt, F.C. Ablation und Epileptogenizität – Zur Beziehung von Läsion und Funktion. Z. Epileptol. 30, 129–137 (2017). https://doi.org/10.1007/s10309-016-0097-7

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