• 来稿:陈琳   北京市虹天济神经科学研究院

  • Brain Res Brain Res Rev. 2004  Mar;44(2-3):141-53. 

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  • Focal treatment for refractory epilepsy:  hope for the future?

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  • Nilsen KE, Cock HR. 

  • Clinical Neurosciences, St. Georges  Hospital Medical School, Cranmer Terrace, London SW17 0RE,  UK.

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  • Despite advances in anti-epileptic drug  therapy and epilepsy surgery in recent years, intractable epilepsy remains a  large clinical problem. Surgical resection, which can have an excellent outcome,  is appropriate for only a minority of patients in whom an identifiable focus in  non-eloquent brain can be identified. Systemic drug delivery is inevitably  limited by the potential for unwanted side effects, due to actions both outside  the CNS and in non-epileptic brain regions. Thus for a substantial number of  patients novel treatment approaches are urgently needed. Both focal drug  delivery and neuronal stem cell grafting have been evaluated in a variety of  experimental epilepsy models in recent years, targeting either the seizure focus  or key propagation pathways. The literature in this field is critically reviewed  and considered in a clinical context. Studies in both areas are hampered by the  limitations of available animal models, and by uncertainties in discerning which  changes in the epileptic brain directly promote seizures, and which are  compensatory. However, in many cases promising, though short-term, results have  been obtained. Before such studies could be considered in humans further  investigations that include long-term seizure and behavioural outcomes, in  clinically relevant experimental models, are required. However, the current  literature does provide proof in principle for a focal treatment approach, which  may offer hope for many currently intractable patients for whom drug  developments and surgical advances have proved  disappointing.


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