Unearthing the mechanisms of responsive neurostimulation for epilepsy.
Unearthing the mechanisms of responsive neurostimulation for epilepsy.
复制标题
DOI：
10.1038/s43856-023-00401-x
复制
发表时间：
2023-11-16
期刊：
影响因子：
--
通讯作者：
Rolston, John D
中科院分区：
文献类型：
--
作者：
Rao, Vikram R;Rolston, John D
响应性神经刺激（RNS）是治疗耐药性局灶性癫痫患者的有效疗法。在临床试验中，RNS 治疗可显着降低中位癫痫发作频率，但个体间的反应差异很大，许多人获益甚微或没有获益。了解为什么会出现这种变异将有助于改善 RNS 疗法的使用。在此，我们主张重新审视有关 RNS 如何减少癫痫发作的假设。由于大量患者已经使用该设备，其中一些患者是长期使用的，因此现在这是可能的。两个基本假设是，设备的颅内引线应直接瞄准癫痫病灶，并且仅应在检测到癫痫样活动时才触发刺激。最近的研究对这两种假设提出了质疑。在这里，我们讨论这些令人兴奋的新研究，并提出未来可以改善临床结果的患者选择、引线放置和设备编程的方法。 Rao 和 Rolston 讨论了针对耐药性癫痫的反应性神经刺激疗法的基本假设的最新挑战。一种新兴的机制模型有助于解释临床结果的变异性，并表明这种疗法可能具有减少癫痫发作的尚未开发的潜力。
Responsive neurostimulation (RNS) is an effective therapy for people with drug-resistant focal epilepsy. In clinical trials, RNS therapy results in a meaningful reduction in median seizure frequency, but the response is highly variable across individuals, with many receiving minimal or no benefit. Understanding why this variability occurs will help improve use of RNS therapy. Here we advocate for a reexamination of the assumptions made about how RNS reduces seizures. This is now possible due to large patient cohorts having used this device, some long-term. Two foundational assumptions have been that the device’s intracranial leads should target the seizure focus/foci directly, and that stimulation should be triggered only in response to detected epileptiform activity. Recent studies have called into question both hypotheses. Here, we discuss these exciting new studies and suggest future approaches to patient selection, lead placement, and device programming that could improve clinical outcomes. Rao and Rolston discuss recent challenges to foundational assumptions underlying responsive neurostimulation therapy for drug-resistant epilepsy. An emerging mechanistic model helps explain variability in clinical outcomes and suggests this therapy may have untapped potential for reducing seizures.