Electrophysiological effects and clinical results of direct brain stimulation for intractable epilepsy
Electrophysiological effects and clinical results of direct brain stimulation for intractable epilepsy
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DOI：
10.1016/j.clineuro.2004.01.009
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发表时间：
2004-09-01
影响因子：
1.9
通讯作者：
Chkhenkeli, IS
中科院分区：
文献类型：
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作者：
Chkhenkeli, SA;Sramka, M;Chkhenkeli, IS
目的：癫痫是兴奋性和抑制性过程失衡的结果。因此，人工增强脑抑制机制的活性可能对难治性癫痫患者产生有益的治疗效果。材料和方法：本文对150例植入脑内电极的病人进行了电刺激尾状核头部（HCN）、小脑齿状核（CDN）、丘脑中央中核（CM）、新皮质和颞叶近基底面癫痫灶的抑制作用研究。对54例患者进行了植入式神经刺激器的慢性脑刺激。16例随访1.5年（平均1.2年）。结果如下：研究表明，4-8 Hz HCN和50-100 Hz CDN刺激抑制亚临床癫痫放电，并减少全身性、复杂部分性和继发性全身性发作的频率。CM刺激（20-130 Hz）使EEG去兴奋并抑制部分运动性癫痫发作。直接阈下1-3 Hz刺激致痫灶可抑制节律性后放电（AD）。54例患者中有26例（48%）消除了癫痫发作，54例患者中有23例（43%）获得了值得改善，54例患者中有5例（9%）未观察到改善。结论：人为地增加脑抑制系统的活性，可抑制癫痫灶的活动，并在长期内使癫痫灶的活动稳定在一个较低的水平，甚至可能是正常的水平。因此，治疗性直接脑刺激可能是治疗难治性和多灶性癫痫的有用工具，并可能与消融手术方法相结合。(C)2004 Elsevier B. V.保留所有权利。
Objective: Epilepsy can be considered as a result of the imbalance of the excitatory and inhibitory processes. Therefore, the artificial enhancement of the activity of brain inhibitory mechanisms might lead to a beneficial therapeutic effect for intractable epilepsy patients. Material and methods: Studies of the inhibitory effects of electrical stimulation of the head of the caudate nucleus (HCN), cerebellar dentate nucleus (CDN), thalamic centromedian nucleus (CM), and neocortical and temporal lobe mesiobasal epileptic foci were performed on 150 patients with implanted intracerebral electrodes. Chronic brain stimulation with implanted neurostimulators was performed on 54 patients. Sixteen were followed up to 1.5 years (mean 1.2 years). Results: The study demonstrated that 4-8 Hz HCN and 50-100 Hz CDN stimulation suppressed the subclinical epileptic discharges and reduced the frequency of generalized, complex partial, and secondary generalized seizures. CM stimulation (20-130 Hz) desynchronized the EEG and suppressed partial motor seizures. Direct subthreshold 1-3 Hz stimulation of the epileptic focus may suppress rhythmic after discharges (ADs). Seizures were eliminated for 26 of 54 patients (48%), worthwhile improvement was achieved for 23 of 54 patients (43%), and no improvement was observed in 5 of 54 patients (9%). Conclusion: The artificial increase of the activity of brain inhibitory system may suppress the activity of epileptic foci, and, in long run, stabilize this epileptic foci activity at a lower, perhaps normal, level. Therapeutic direct brain stimulation, therefore, might serve as a useful tool in the treatment of intractable and multifocal epilepsy, and might be combined with ablative surgical methods. (C) 2004 Elsevier B.V. All rights reserved.