てんかん外科のための発作症候学(<特集>器質性病変を持つてんかんの外科治療)  [in Japanese] Ictal Semiology of Seizures for Epilepsy Surgery(<SPECIAL ISSUE>Surgery of Epilepsy with Structural Lesions)  [in Japanese]

てんかん外科を考慮する際,術前評価として発作症候を的確に把握し,焦点部位を同定することが重要である.手術の適応となる症例の多くは局在関連てんかんであり,側頭葉てんかんでは複雑部分発作,前頭葉てんかんでは運動にかかわる発作,頭頂葉では知覚異常発作,後頭葉では視覚異常発作というように,焦点部位により特徴的な症状がみられる.また全般性てんかんにおいても発作所見より脳梁離断術の有効な症例がある.さらに多発性病変を有するてんかんにおいても,発作症状の分析により焦点部位を診断し,一部分の病変切除により発作を消失させることが可能である.てんかん症候学に精通することが,よりよい手術成績をもたらすために重要な第一ステップとなる.

Detailed interviews of epileptic seizures are important for the diagnosis of epilepsy and for also determining the optimal treatment modalities. Epilepsy surgery is commonly effective in patients with focal epilepsy. These patients have characteristic seizure features which depend on the location of the focus. For example, complex partial seizures are characteristic in the temporal lobe epilepsy, seizures related to motor functions are common in frontal lobe epilepsy, somatosensory seizures are also sometimes observed in parietal lobe epilepsy and visual auras are frequent in occipital lobe epilepsy. Corpus callosotomy is beneficial in some types of generalized epilepsies, such as drop attacks. Furthermore, the elimination of seizures can sometimes be achieved by a single resection of cortical lesions in some epilepsy patients with multiple cortical lesions. When considering epilepsy surgery, a precise analysis of such seizures is essential for accurately identifying the epileptic focus and thus obtaining good surgical results.