てんかんの治療戦略:てんかん外科における言語機能温存へ向けた試み  [in Japanese] Strategy for epilepsy surgery: mapping the dual language pathways for preservation of language function  [in Japanese]

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Author(s)

    • 松本 理器 Matsumoto Riki
    • 京都大学大学院医学研究科臨床神経学 Department of Neurology, Kyoto University Graduate School of Medicine
    • 下竹 昭寛 Shimotake Akihiro
    • 京都大学大学院医学研究科てんかん・運動異常生理学講座 Department of Epilepsy, Movement disorders and Physiology, Kyoto University Graduate School of Medicine
    • 山尾 幸広 Yamao Yukihiro
    • 京都大学大学院医学研究科脳神経外科 Department of Neurosurgery, Kyoto University Graduate School of Medicine
    • 國枝 武治 Kunieda Takeharu
    • 愛媛大学大学院医学系研究科脳神経外科 Department of Neurosurgery, Ehime University Graduate School of Medicine

Abstract

<p>てんかん患者の約3割は薬剤に抵抗性であり,治療の選択肢としててんかん焦点の切除術が根治療法として知られている.てんかんの焦点と焦点周囲の機能野の同定を行ったうえで,言語機能など重要な脳機能野の温存を図りつつ,焦点を症例ごとにテーラーメードに切除する.心理学的手法を取り入れた低侵襲の高頻度皮質電気刺激変法,皮質脳波信号解析・デコーディング,単発皮質電気刺激を用いた電気的線維追跡法,解剖的白質線維追跡法といった新たなシステム神経科学的手法を複合的に用いた言語二重経路同定・温存の試みについて紹介する.言語関連領域の切除でも術後回復する症例も経験され,縦断的研究から今後代償機転の解明が望まれる.</p>

<p>Epilepsy surgery is a treatment option for patients with epilepsy who failed multiple antiepileptic drugs. After detailed investigations for probing the epileptic focus and surrounding functional brain regions, tailor-made resection of the epileptic focus is performed seeking for seizure freedom. Language function is one of the most important higher functions to be preserved in epilepsy and tumor surgery. We have combined the state-of-art systems neuroscience methods to explore and preserve the dual language pathways, such as a less invasive electrical cortical stimulation method, signal analyses and decoding of electrocorticogram (ECoG), cortico-cortical evoked potential, anatomical fiber tractography and longitudinal neuropsychology evaluation. We here report the comprehensive language mapping of the dual language pathway, its clinical application to awake brain surgery, and the novel findings for neural basis of the language dual stream. According to recent function and connectivity studies, the basal temporal language area at and around the anterior fusiform gyrus is one of the crucial regions for semantic memory and is involved in the ventral language pathway. For QOL improvement after epilepsy surgery, a comprehensive multidisciplinary longitudinal study is warranted to delineate the brain plasticity for language functions.</p>

Journal

  • Japanese Journal of Neuropsychology

    Japanese Journal of Neuropsychology 34(2), 124-134, 2018

    Neuropsychology Association of Japan

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