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癫痫难治?来试试脑起搏器

2017-08-04 04:32:06   中国青年网

全世界约有5000万名癫痫患者,超过900万人在中国,药物难治性癫痫超过300万人。在中国,癫痫已经成为神经科仅次于脑血管病的第二大常见病,总体患病率为7‰。可就诊情况并不乐观,癫痫患者的就诊率还不到40%。

这也说明,关于癫痫的防治知识知晓率仍然较低。对于癫痫这种病理复杂的疾病,如何治愈仍然在探索的路上。

癫痫药物治疗首选“单药”

在医学上,癫痫是一种以具有持久性的致痫倾向为特征的脑部疾病。北京市癫痫诊疗中心主任、宣武医院神经内科主任王玉平教授介绍,临床出现两次(间隔至少24小时)非诱发性癫痫发作时就可确诊为癫痫。其发作症状为抽搐、神志不清、痉挛、感觉异常等,长期频繁发作可严重影响患者的身心、智力。

导致癫痫疾病的原因有内在遗传因素,也有外界环境因素。与帕金森病不同,癫痫可以治愈。只要接受及时、正规的治疗,50%至60%的患者经过2年至5年的治疗可以痊愈。家族中有癫痫病史,以及有能引起癫痫的严重遗传性疾病,相关亲属应高度警惕,女性应进行产前诊断。儿童癫痫会影响到大脑和身体各个器官,继而影响发育和成长;成人癫痫会对患者身体、精神、婚姻、社会经济地位,造成严重不良影响。

从癫痫的分类来看,局灶性癫痫发作指恒定起源于一侧大脑半球内的致痫网络,并具有放电的优势传导途径,可以累及对侧脑半球。全面性癫痫发作则起源于双侧大脑皮质及皮质下结构所构成的致痫网络中的某一点,并快速波及整个网络,且每次发作起源点位置不固定。

癫痫的最初治疗手段是根据年龄、症状类型、严重程度等选择药物。常见的一线药物有丙戊酸、卡马西平、拉莫三嗪、奥卡西平、左乙拉西坦、苯巴比妥。通常,应首选“单药”治疗以减少药物副作用,若病情需要再给予合理的联合用药治疗。用药疗程要“足”,经评估可以撤药时要“慢”。

治疗新方向:“脑深部电刺激”

癫痫的发病率约是帕金森病的10倍,大多数患者的病因与脑发育异常有关。70%至80%的患者可以使用药物控制病情,剩下的人则需要手术治疗。

从手术的角度来说,最好的结果当然是切除病灶,因为切除意味着病情不再发作,癫痫得到治愈。但手术对一些患者起不到效果,比如,找不到具体病灶在哪儿,或者切掉病灶会影响患者的脑功能。这时,医生会考虑选择“脑深部电刺激(DBS)”来治疗。

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