焦点切除術後に行動異常が改善した小児前頭葉てんかんの1例  [in Japanese] Behavioral Improvement Following Focal Resection in a Child with Frontal Lobe Epilepsy : A Case Report  [in Japanese]

小児てんかんは時に注意障害・多動などの行動異常を伴い、内科的治療による支持療法ではそのコントロールが困難である症例が存在する。3歳よりてんかんと重度の行動異常を発症し、器質的病変を確認できない前頭葉てんかんの7歳男児に対し、左前頭葉切除術を施行し、発作消失と同時に行動異常が改善した症例を経験した。SNAP (Swanson,Norlan and Pelham)症状評価スケールを用いて術前術後の不注意、および多動・衝動性の行動変化を観察したところ、多動・衝動性に関する項目の改善がより顕著に認められた。本症例では、てんかんの焦点切除術により、てんかんと強度の行動異常が共に改善しており、左前頭葉切除がてんかん発作を消失させたと同時に、行動異常が同部位の機能異常と関係していることを示唆している。

Epilepsy in childhood sometimes involves behavioral problems, which are refractory to medical treatment. We describe a 7-year-old boy with frontal lobe epilepsy and severe behavioral problem, which dramatically improved following epilepsy surgeries. He had a severe attention deficit described as "acting vigorously as if driven by a motor", as well as severe mental retardation since 3 years old. He underwent anterior 2/3 callosotomy followed by two-time resections of left frontal lobe, and achieved not only complete seizure freedom but dramatic behavioral improvement. SNAP (Swanson, Norlan and Pelham) rating scale adjusting for him showed marked improvement in the component of his hyperactivity and impulsiveness. This case highlighted strong relation between frontal lobe epilepsy and behavioral impairment in childhood from the surgical perspective. The improvement of the behavior as well as epileptic seizures following the left frontal lobe resection in the present patient indicated that epileptic focus in the left frontal lobe was also responsible for the behavioral disorder.