事件记录
面试官: 有人被诊断患有癫痫, 服用药物治疗癫痫, 一年后还会癫痫发作. 你什么时候去看专科医生?
Dr. 信德理查兹 是医学难治性专家吗 癫痫. Dr. 理查兹，什么时候会有人来看你?
Dr. 理查兹: 所以大发娱乐肯定说一年应该是一般的指导方针, 但大发娱乐试着更积极一点. So, 现在, the American Academy of 神经学 has set out like a guideline saying that if a patient with 癫痫 has been seen by the primary care provider and it's been three months where they're unable to treat the seizures effectively, 他们应该去看神经科医生, 神经科医生或癫痫专科医生. 然后，如果一个病人正在看 一般的神经学家 for a year with untreated seizures, those people should definitely be referred to an 癫痫 center.
面试官: 当你到了那一年, 如果你在没有药物治疗的情况下仍然癫痫发作，你真的不应该推迟. 这样做有哪些危险呢?
Dr. 理查兹: In terms of the biggest concern we get about uncontrolled seizures is there's a phenomenon called SUDEP, 它代表癫痫症导致的无法解释的突然死亡. 大发娱乐真的不知道它的机制. 大发娱乐只知道癫痫发作不受控制的人患这种病的几率更高. 所以这是大发娱乐对癫痫发作失控的人最担心的事情.
然后, 就像其他并发症一样, 所以人们, 你知道, 持续发作确实会影响日常生活. 所以当你癫痫发作时，你不能开车. 你不能操作重型机械，也不能站在高处. 所以这也取决于你的工作情况. 但对人们影响最大的是驾驶方面. 所以从这个意义上说，它真的会影响你的生活质量.
然后, 也取决于癫痫发作的来源, 大多数人在癫痫发作时都会出现一些记忆问题. 这是一种常见的并发症，大发娱乐会尽量避免，如果大发娱乐能及早治疗的话.
面试官: 这时，他们走进你的办公室. Walk me through the diagnosis process that you use to get to a diagnosis of medically refractory 癫痫. 据我所知, 你可能首先看到的是, 癫痫的初步诊断是正确的吗?" 因为 I guess it's like 13% to 15% of people that are diagnosed with 癫痫 actually have something else.
Dr. 理查兹: 是的,完全. 这也是需要澄清的重要一步. 其中一种方法是, 很明显, 了解病人的病史了解他们到底在做什么. But also a really important aspect is getting a history from the bystanders because they're the ones that are seeing what the patient's actually doing.
A very common diagnosis that 癫痫 can be confused with is what we call psychogenic non-epileptic spells. 所以有些人, 因为压力或焦虑, their body can react in a way where it looks like they're having a seizure when actually they're not. 比如，大发娱乐观察大脑活动，在这段时间里，它实际上是完全正常的. 所以如果大发娱乐对诊断不确定，这绝对是尝试确认的第一步. 大发娱乐通常这样做的方法之一, 在癫痫中心可以买到, 大发娱乐把病人带到医院然后用脑电图监测他们, 哪个是脑电波研究. And we try to capture their typical episodes so that we can see exactly what's going on in the brain. 如果他们确实患有癫痫，它可以大发娱乐大发娱乐了解它来自大脑的哪个部位. 这通常是大发娱乐明确诊断的第一步.
然后, 在那之后, 才能被诊断为医学上难治性癫痫, you have had to have an adequate trial of two anti-epileptic drugs and are continuing to have seizures. So in terms of what we mean by adequate trials is a lot of people stop medications because they have side effects from them, 所以这并不意味着一个充分的审判. 所以如果你因为副作用而停药，而你仍然有癫痫发作, you still have to have a good trial of two drugs before you can be considered medically refractory 癫痫.
面试官: So, 此时此刻, 如果你这样做了，那么诊断是医学上难治性癫痫, 这个点的步骤是什么?
Dr. 理查兹: 当你看到一个被诊断患有癫痫的病人，你开始使用一种新的药物, 抗癫痫药, 大约50%的患者会在这种情况下不再发作. 所以这是一个很好的数量的人将不会癫痫发作. 一旦你服用第二种药物，另外13%的人不会癫痫发作.
So then you're kind of left in this third category of patients who are not seizure-free on medications. 你通常会尝试不同的试验，但他们还是会癫痫发作. So it's that third of patients who are diagnosed with 癫痫 that are considered the medically refractory.
所以, 你知道, 如我所说, 这些人主要担心的是癫痫发作的长期副作用, 突然死亡的风险. 所以大发娱乐确实尝试大发娱乐提供其他选择. 大发娱乐大发娱乐提供的最大选择之一就是手术. 所以在大发娱乐考虑手术之前还有很多工作要做，因为, 你知道, that is a very big step and it's a big deal for us and for patients too to go through potential brain surgery.
这是第一步, 在治疗难治性癫痫方面, 把人带到医院来治疗他们的癫痫发作吗. 因为, 以便了解病人有哪些手术选择, 大发娱乐得知道癫痫可能来自哪里. 所以大发娱乐要做的就是把病人带进来, we'll stop all of their anti-epileptic drugs because we want them to have a seizure when they're in the hospital. 然后, once we've gotten about two to three seizures and they're reliably from the same location or let's say they show us that the patient has seizures coming from several different locations, 大发娱乐就知道下一步该怎么做了. 这是第一步.
然后, 在那之后, we typically try to do some non-invasive evaluations to help us pinpoint even more where the seizures are coming from. 这包括不同类型的成像. So patients will definitely get an MRI because we try to see if there's a reason or a lesion or a structural cause as to why they are having seizures.
然后大发娱乐还会做一些更高级的成像. 所以大发娱乐要做PET扫描，也就是核扫描. 所以大发娱乐注射染料然后观察大脑的活动区域. 通常，在癫痫发作的病人中，大脑的活动在他们癫痫发作的时候会减少. 所以这可以大发娱乐大发娱乐找到癫痫发作的原因.
然后大发娱乐通常会把他们送到神经心理学家那里. 神经心理学家会观察他们的记忆, 他们的语言, and other important functions of the brain so we can figure out where these important functions are and to make sure that they aren't affected when we consider surgery.
然后, 最后, 也可以这样做, 大发娱乐做的是功能性核磁共振成像, where we ask them to do some different language tasks and some different motor tasks because then we can see exactly where in the brain it lights up and we know where those tests are coming from so we avoid those areas in surgery as well. So there's quite an extensive workup to do before you even consider the surgical options for a patient.
面试官: 在你做完所有这些测试之后, 你会更清楚你要面对的是什么, 手术的重点在哪里. 在这一点上, 病人接受的手术类型真的是基于这些测试的结果吗, 或者病人在手术过程中必须做出一些选择?
Dr. 理查兹: 是的. 所以大发娱乐肯定可以做出选择, whether like how invasive the patient is willing to go versus like if they want to be a little more conservative, 因为大发娱乐有办法取出大脑. 但大发娱乐也有很多神经调节, 哪些设备不需要任何专业, 你知道, 在脑部手术中移除头骨之类的东西. So it's a ongoing discussion with the patient about what we think would be the benefits versus risks and what they feel like would be an acceptable surgery and things like that.
在这些初步测试完成后，大发娱乐通常会将脑电图电极直接植入大脑. 所以这是个小手术, 大发娱乐在头骨上钻个洞然后把电极直接插入大脑. 这样大发娱乐就能更精确地定位癫痫发作的来源. 所以这通常是大发娱乐在考虑手术前要做的一步.
面试官: 你提到了一些结果比如减少了50%. 一般来说，外科手术可以减少癫痫发作? 然后, 你知道, 如果仍然有癫痫发作, 未来如何解决这些问题, 你知道, 一个人对药物有抗药性, 不能用药物控制吗?
Dr. 理查兹: 是的. 这就是为什么大发娱乐喜欢尽早接触患者因为数据显示 . . . so let's say you have a patient with medically refractory 癫痫 and you continue to try to treat them with different medicines. 这些人中只有8%的人不会癫痫发作. 与手术相比，大约65%的人不会癫痫发作. 所以在癫痫发作自由方面这是一个很大的不同. 你甚至可以想象, 如果人们不能摆脱癫痫, 至少可以显著减少癫痫发作.
所以最重要的是要知道做过癫痫手术的人, 它不是药物的替代品. 所以这些人通常会继续服用药物以确保大发娱乐控制癫痫发作. 这只是意味着他们服用的药物可能更少, 这很好，因为药物会产生副作用, 它可能不需要那么多. So that's an important thing to clarify for people because people think they can just get surgery and come off everything. 但大发娱乐必须让人们继续用药，给他们最大的机会避免癫痫发作.
面试官: 我想它会因不同类型的手术而有所不同，因为, 你知道, 你提到的一些实际上需要打开头骨, 我都不好意思说出来. 听起来有点吓人. 还有一些非侵入性的手术. 病人接受手术后会有什么样的恢复呢?
Dr. 理查兹: 是的. 对于侵入性的，你有两种 . . . 侵入性手术就像肺叶切除术. 对于这个问题, 我会说, 你知道, 比如在医院里的人, 他们只在医院住几天, 但通常需要一个月的时间, 我想说的, 才能从手术中完全恢复. 就神经调节过程而言, the patients usually go home the next day and there really isn't that much of a significant recovery, 人们做得很好.
面试官: 我不知道这是否会引出一个问题, 但是听你讲诊断和治疗的过程, 大发娱乐能做到这一切是多么不可思议, 正确的? That you have the equipment and the expertise and the training to be able to go in and pinpoint where this problem might be in the brain and then be able to go in and do something about that. I mean does that resonate with you on any level whatsoever or is it just something you do 此时此刻?
Dr. 理查兹: 是的. 这就是我爱上癫痫的原因. 你知道, 通过神经内科住院医师, 大发娱乐确实要处理很多不同的破坏性情况. 但对于癫痫，我真的觉得大发娱乐可以做些什么，大发娱乐可以大发娱乐提供一些东西. And the surgical options for 癫痫 is really what brought me into this field because I felt that it was just amazing that what we could do and the different devices, and I think we're continuing to kind of develop more and more things that are going to be on the horizon. 就像, 十年前, it wouldn't have been an option for this patient to have gotten that surgery and she still would have been having seizures. 所以我继续抱有希望, 沿着这条线, 大发娱乐会有更多的选择, especially for our generalized patients because these people don't have a lot of surgical options 此时此刻.