Differential neuropsychological outcomes following targeted responsive neurostimulation for partial-onset epilepsy
Differential neuropsychological outcomes following targeted responsive neurostimulation for partial-onset epilepsy
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DOI：
10.1111/epi.13191
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发表时间：
2015-11-01
期刊：
影响因子：
5.6
通讯作者：
Morrell, Martha J.
中科院分区：
文献类型：
--
作者：
Loring, David W.;Kapur, Ritu;Morrell, Martha J.
当作为药物难治性部分性癫痫发作患者的连续治疗时，神经刺激反应性神经刺激可降低致残性癫痫发作的频率。长期反应性神经刺激对神经心理学性能的影响尚未建立。MethodsNeuropsychological数据收集自参与RNS（R）系统反应性神经刺激随机对照试验的开放标签臂的受试者。主要认知结果是波士顿听觉语言学习测验（BNT）和雷伊听觉语言学习测验（AVLT）。在基线时评估神经心理学表现，并在RNS系统治疗1年和2年后再次评估。进行了随访分析，限制在内侧颞叶或neocortical.ResultsNo显着的认知能力下降，观察到任何神经心理学措施，通过2年的癫痫发作的患者。当作为癫痫发作区域的函数进行检查时，发现了双重分离，所有患者的命名显著改善（p < 0.0001），并且对于新皮质癫痫发作的患者（p < 0.0001），但对于内侧颞叶（MTL）癫痫发作的患者（p = 0.679）没有显著改善。相比之下，在所有患者中观察到言语学习的显著改善（p = 0.03），并且对于MTL癫痫发作的患者（p = 0.005），但对于新皮质发作的患者（p = 0.403）没有显著改善。事实上，在新皮层发作的患者中对命名有小但显著的有益治疗效果，在MTL结构中癫痫发作的患者中对言语学习有适度改善。这些结果表明，在某些领域有适度的认知改善，这些领域因癫痫发作的区域而异。
ObjectiveResponsive neurostimulation decreases the frequency of disabling seizures when used as an adjunctive therapy in patients with medically refractory partial-onset seizures. The effect of long-term responsive neurostimulation on neuropsychological performance has not yet been established.MethodsNeuropsychological data were collected from subjects participating in the open-label arm of a randomized controlled trial of responsive neurostimulation with the RNS (R) System. Primary cognitive outcomes were the Boston Naming Test (BNT) and Rey Auditory Verbal Learning (AVLT) test. Neuropsychological performance was evaluated at baseline and again following 1 and 2 years of RNS System treatment. Follow-up analyses were conducted in patients with seizure onset restricted to either the mesial temporal lobe or neocortex.ResultsNo significant cognitive declines were observed for any neuropsychological measure through 2 years. When examined as a function of seizure onset region, a double dissociation was found, with significant improvement in naming across all patients (p < 0.0001), and for patients with neocortical seizure onsets (p < 0.0001) but not in patients with mesial temporal lobe (MTL) seizure onsets (p = 0.679). In contrast, a significant improvement in verbal learning was observed across all patients (p = 0.03), and for patients with MTL seizure onsets (p = 0.005) but not for patients with neocortical onsets (p = 0.403).SignificanceTreatment with the RNS System is not associated with cognitive decline when tested through 2 years. In fact, there were small but significant beneficial treatment effects on naming in patients with neocortical onsets and modest improvements in verbal learning for patients with seizure onsets in MTL structures. These results suggest that there are modest cognitive improvements in some domains that vary as a function of the region from which seizures arise.