Izostanak epileptičkih napadaja nakon selektivne amigdalohipokampektomije

master's thesis

• Title (english): Seizure-free outcome after selective amygdalohippocampectomy
• Author: Niko Njirić
• Mentor: Goran Mrak (mentor)
• Committee member: Josip Paladino (predsjednik povjerenstva)
• Committee member: Tomislav Meštrović (član povjerenstva)
• Committee member: Goran Mrak (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Surgery); Zagreb
• Defense date and country: 2017-07-14, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Surgery
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Neurology

Abstract

Epilepsija je česta neurološka bolest koja pogađa oko 0.6-1% svjetske populacije. Otprilike jedna trećina oboljelih ne uspijeva postići izostanak epileptičkih napadaja korištenjem antiepileptičkih lijekova. U takvih je bolesnika nužno provesti dijagnostičku obradu kako bi se ustanovio mogući strukturni uzrok epilepsije i farmakorezistencije. Najčešći uzrok ovakvog oblika bolesti jest mezijalna temporalna skleroza, stanje karakterizirano gubitkom piramidalnih neurona u hipokampusu. Kliničku sliku epilepsije s mezijalnim temporalnim ishodištem karakterizira pojava viscerosenzornih auri, njušnih fenomena i oroalimentarnih automatizama. Kirurške tehnike liječenja ovog stanja su mnoge, a jedna od poštednijih je selektivna amigdalohipokampektomija, kod koje se odstranjuju hipokampus, amigdala i parahipokampalni girus. U ovom radu obrađeni su podaci 76 bolesnika operiranih ovom kirurškom tehnikom putem transsilvijskog pristupa te je analiziran ishod operacijskog liječenja. U 51 (67.1%) bolesnika je postignut ishod potpunog izostanka napadaja, a smanjenje broja lijekova je postignuto u 33 (43.4%) bolesnika nakon operacije. Ovi podaci ukazuju na to da je selektivna amigdalohipokampektomija djelotvorna tehnika kirurškog liječenja epilepsije. U bolesnika s farmakorezistentnim oblikom epilepsije je nužno ovaj modalitet liječenja primijeniti što ranije, budući da se u velikom postotku slučajeva postiže izostanak epileptičkih napadaja, a samim time i bitno poboljšanje zdravstvenog stanja bolesnika te sprječavanje daljnjeg propadanja kognitivnih funkcija.

Abstract (english)

Epilepsy is a common neurological disease, affecting approximately 0.6-1% of the global population. About one-third of epilepsy patients do not achieve seizure freedom with the use of antiepileptic drugs. It is necessary to perform a diagnostic work-up in these patients, in order to determine the existence of a potential structural cause of epilepsy and pharmacoresistancy. The most common cause of this condition is mesial temporal sclerosis, characterized by a loss of piramidal cells in the hippocampus. Signs and symptoms of epilepsy with a mesial temporal lobe focus include: viscerosensory auras, olfactory phenomena and oroalimentary automatisms. There are multiple surgical techniques available for treatment of this disease. Selective amygdalohippocampectomy is one of the most sparing among them. It involves the removal of the hippocampus, amygdala and the parahippocampal gyrus. This study analyses the outcomes of 76 patients who were surgically treated with the aforementioned technique, via a transsylvian approach. Seizure freedom was achieved in 51 (67.1%) patients. A decrease in the number of antiepileptic drugs was achieved in 33 (43.4%) patients. This data suggests selective amygdalohippocampectomy is an efficient technique of surgical epilepsy treatment. It is imperative to evaluate patients with pharmacoresistant epilepsy as soon as possible, since surgery provides seizure freedom in a large percentage of cases, thereby enhancing the health of these individuals and halting further deterioration of cognitive functions.

• Keywords: epilepsija; ishodi izostanka napadaja; kirurgija epilepsije; mezijalna temporalna skleroza; selektivna amigdalohipokampektomija
• Keywords (english): epilepsy; epilepsy surgery; mesial temporal sclerosis; selective amygdalohippocampectomy; seizure outcome
• Language: croatian
• URN:NBN: urn:nbn:hr:105:620800
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2018-03-21 10:51:31