Tratamiento Quirúrgico de la Epilepsia Farmacorresistente. 20 años de experiencia de la Fundación Centro Colombiano de Epilepsia y Enfermedades Neurológicas.
Palabras clave:
Epilepsia, cirugía, Epilepsy, surgical treatmentResumen
ResumenPropósito: Presentar nuestra experiencia y describir las características clínicas, los desafíos quirúrgicos y el resultado de la cirugía de las epilepsias en pacientes adultos y niños.
Método: Análisis retrospectivo de 552 cirugías de epilepsia realizadas en la Fundación Centro Colombiano de Epilepsia y Enfermedades Neurológicas entre 1989 y 2008, de un total de 750 cirugías.
Resultados: Desde 1989 hasta 2009 se han realizado 750 cirugías de epilepsia. 552 pacientes, cumplían con todos los criterios de la inclusión para el estudio en mención. Todas las resecciones quirúrgicas fueron realizadas por el mismo neurocirujano (JFF) y todos los pacientes ingresaron al mismo protocolo. El control postoperatorio de las crisis tuvo un rango de 30% al 70% dependiendo del tipo de intervención quirúrgica. La morbilidad y la mortalidad estuvieron en el orden del 1%.
Conclusión: La evaluación de los pacientes con epilepsia medicamente intratable debe estar a cargo de un grupo de especialistas en epilepsia dentro de centro especializado en cirugía de epilepsia. No hay restricciones en la edad para la cirugía de la epilepsia, ni restricciones en relación al síndrome epiléptico y el tipo de intervención. El control de las crisis alcanza porcentajes de éxito hasta del 70% en los pacientes postquirúrgicos, sin embargo es variable si la meta de la cirugía es paliativa o curativa. La rehabilitación es fundamental para la calidad de vida de estos pacientes. Nuestra experiencia fortalece la continuidad de los programas de cirugía de epilepsia.
Palabras clave: Epilepsia, cirugía.
SummaryObject: To present the experience of a center in epilepsy surgery and to describe the clinical characteristics, surgical challenges, and outcome in epilepsy surgery.
Methods: Retrospective analysis of 552 epilepsy surgeries is presented.
Results: Since 1989, when we opened the epilepsy surgery program in our center, until 2009, we have operated on 750 patients for epilepsy surgery. 552 patients had all the inclusion criteria for our study. All surgical resections were performed by the same Neurosurgeon (FFJ). Every patient was studied with video-EEG and received the same protocol. Seizure control was 30% to 70% of patients after surgery and varies depending whether the procedure was a palliative o therapeutic. Operative morbidity and mortality was 1%.
Conclusions: A teem of epileptologists, neurosurgeons and neuropsychologists at a center offering epilepsy surgery, should evaluate patients who are not seizure controlled after failure of two to three AEDs. Generally, the most refractory cases are those patients with symptomatic substrates, and they are often excellent surgical candidates. There are no age restrictions for epilepsy surgery, nor is epilepsy surgery restricted to a single epilepsy syndrome or type of operation. Seizure control can be expected in 50% to 70% of patients after surgery and varies
by operative used technique and whether the goal of surgery was palliative or curative. The rehabilitation is crucial to the quality of life of these patients. Our experience in a transitional country, aims us to continuing with this important procedure.
Key Words Epilepsy, surgical treatment
Biografía del autor/a
Ginna de la Rosa-Manjarrez, Universidad de Cartagena.
Jaime Fandiño-Franky, Universidad de Cartagena
Gian Carlos Conde-Cardona, Universidad Rafael Núñez.
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