Application of RNS in refractory epilepsy: Targeting insula.
Application of RNS in refractory epilepsy: Targeting insula.
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RNS（反应性神经刺激系统）在难治性癫痫中的应用：以脑岛为靶点
DOI：
10.1002/epi4.12061
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发表时间：
2017-09-01
期刊：
影响因子：
3
通讯作者：
Friedman, Daniel
中科院分区：
文献类型：
--
作者：
Chen, Hai;Dugan, Patricia;Friedman, Daniel
虽然反应性神经刺激（RNS）被批准用于治疗成人难治性局灶性癫痫，但对特定皮质靶点治疗的反应知之甚少。我们描述了RNS靶向岛叶的经验。我们确定了2014年4月至2015年10月期间在颅内至少植入一个电极的RNS植入患者。我们对术前临床特征、影像学、心电图（EEG）、术中皮质电图（ECoG）和术后癫痫结局进行了回顾性分析。确定了8例植入后随访至少6个月的患者。MRI或头皮EEG检查无法确定发作位置。颅内EEG监测或术中ECoG显示颅内有明确的发作发作和/或频繁的发作间期放电。4例患者的癫痫发作频率总体降低了50-75%。两名患者没有表现出明显的癫痫发作改善。一名患者的癫痫发作频率降低了75%，另一名患者术后几乎没有癫痫发作。没有报告岛叶RNS电极放置或刺激的直接并发症，尽管2例患者发生了被认为与开颅术相关的术后并发症（脑积水和晚期感染）。我们的研究表明，岛叶RNS电极放置在选定的患者是相对安全的，RNS治疗可能有利于选定的岛叶癫痫患者。
Although responsive neurostimulation (RNS) is approved for treatment of resistant focal epilepsy in adults, little is known about response to treatment of specific cortical targets. We describe the experience of RNS targeting the insular lobe. We identified patients who had RNS implantation with at least one electrode within the insula between April 2014 and October 2015. We performed a retrospective review of preoperative clinical features, imaging, electrocardiogram (EEG), intraoperative electrocorticography (ECoG), and postoperative seizure outcome. Eight patients with at least 6 months of postimplant follow-up were identified. Ictal localization was inconclusive with MRI or scalp EEG findings. Intracranial EEG monitoring or intraoperative ECoG demonstrated clear ictal onsets and/or frequent interictal discharges in the insula. Four patients demonstrated overall 50-75% reduction in seizure frequency. Two patients did not show appreciable seizure improvement. One patient has experienced a 75% reduction of seizure frequency, and another is nearly seizure free postoperatively. There were no reported direct complications of insular RNS electrode placement or stimulation, though two patients had postoperative complications thought to be related to craniotomy (hydrocephalus and late infection). Our study suggests that insular RNS electrode placement in selected patients is relatively safe and that RNS treatment may benefit selected patients with insular epilepsy.