Brain stimulation for the treatment of epilepsy
Brain stimulation for the treatment of epilepsy
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DOI：
10.3171/2012.1.focus11334
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发表时间：
2012-03-01
影响因子：
4.1
通讯作者：
Yoshor, Daniel
中科院分区：
文献类型：
--
作者：
Fridley, Jared;Thomas, Jonathan G.;Yoshor, Daniel
难治性癫痫患者的治疗一直充满挑战。尽管有多种抗癫痫药物和手术切除癫痫灶，但仍有一小部分癫痫患者无能为力。目前针对这些不幸患者的可用治疗方案包括迷走神经刺激、生酮饮食以及直接和间接电刺激被认为与癫痫发生有关的脑核。大脑电刺激治疗癫痫的研究可以追溯到 20 世纪初，始于小脑刺激的研究。多年来，潜在目标的数量不断增加，包括海马、丘脑底核、尾状核、中心正中核和丘脑前核 (ANT)。最近发表了一项大型随机对照试验的结果，即电刺激丘脑前核治疗癫痫 (SANTE) 试验，表明 ANT 刺激可显着降低平均癫痫发作频率。不久之后，即 2011 年，第二项随机对照试验——NeuroPace RNS 试验——的结果发表了。 RNS 试验检查了难治性部分性癫痫患者癫痫病灶的闭环反应性皮质刺激，再次发现癫痫发作频率显着降低。在本综述中，作者回顾了大脑电刺激治疗癫痫的现代历史，并讨论了最近发表的两项重要试验（SANTE 和 RNS 试验）的结果。 （http://thejns.org/doi/abs/10.3171/2012.1.FOCUS11334）
The treatment of patients with refractory epilepsy has always been challenging. Despite the availability of multiple antiepileptic medications and surgical procedures with which to resect seizure foci, there is a subset of epilepsy patients for whom little can be done. Currently available treatment options for these unfortunate patients include vagus nerve stimulation, the ketogenic diet, and electric stimulation, both direct and indirect, of brain nuclei thought to be involved in epileptogenesis. Studies of electrical stimulation of the brain in epilepsy treatment date back to the early 20th century, beginning with research on cerebellar stimulation. The number of potential targets has increased over the years to include the hippocampus, subthalamic nucleus, caudate nucleus, centromedian nucleus, and anterior nucleus of the thalamus (ANT). Recently the results of a large randomized controlled trial, the electrical Stimulation of the Anterior Nucleus of Thalamus for Epilepsy (SANTE) trial, were published, demonstrating a significant reduction in mean seizure frequency with ANT stimulation. Soon after, in 2011, the results of a second randomized, controlled trial-the NeuroPace RNS trial-were published. The RNS trial examined closed-loop, responsive cortical stimulation of seizure foci in patients with refractory partial epilepsy, again finding significant reduction in seizure frequency. In the present review, the authors examine the modern history of electrical stimulation of the brain for the treatment of epilepsy and discuss the results of 2 important, recently published trials, the SANTE and RNS trials. (http://thejns.org/doi/abs/10.3171/2012.1.FOCUS11334)