Cortical and thalamic electrode implant followed by temporary continuous subthreshold stimulation yields long-term seizure freedom: A case report.
Cortical and thalamic electrode implant followed by temporary continuous subthreshold stimulation yields long-term seizure freedom: A case report.
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DOI：
10.1016/j.ebr.2020.100390
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发表时间：
2020
影响因子：
--
通讯作者：
Lundstrom BN
中科院分区：
文献类型：
--
作者：
Alcala-Zermeno JL;Gregg NM;Van Gompel JJ;Stead M;Worrell GA;Lundstrom BN
靶向致痫网络的神经调节策略是治疗局灶性耐药癫痫的选择。这些脑刺激方法包括响应性神经刺激和最近的慢性阈下刺激。神经调节的长期无癫痫发作是罕见的。癫痫控制通常需要持续的电刺激。在这里，我们介绍的情况下，植入三个皮质电极靶向下额叶，丘脑，和一个皮质下电极靶向同侧丘脑前核的患者。该患者接受了连续7个月的额叶电极亚阈值电刺激，此时刺激意外停止。他已经42个月没有癫痫发作了。该病例表明神经调节可以改变致癫痫网络并在不进行电刺激的情况下导致癫痫发作自由的可能性。脑刺激可以治疗耐药性局灶性癫痫发作，但很少导致癫痫发作自由。持续的脑刺激通常被认为是提供治疗效果所必需的。我们介绍了一个病人，实现癫痫发作自由后，几个月的脑刺激。在意外停止脑刺激后，患者保持癫痫发作自由超过三年。这个病例表明，大脑刺激可能会永久地调节神经回路。
Neuromodulation strategies that target the epileptogenic network are options for treating focal drug-resistant epilepsy. These brain stimulation approaches include responsive neurostimulation and more recently, chronic subthreshold stimulation. Long-term seizure freedom with neuromodulation is uncommon. Seizure control typically requires ongoing froms of electrical stimulation. Here, we present the case of a patient implanted with three cortical electrodes targeting the inferior frontal lobe, insula, and one subcortical electrode targeting the ipsilateral anterior thalamic nucleus. This patient received continuous subthreshold electrical stimulation to the frontal electrodes for 7 months, at which time stimulation was inadvertently stopped. He has now been free of seizures for 42 months. This case suggests the possibility that neuromodulation can alter epileptogenic networks and lead to seizure freedom without ongoing electrical stimulation. Brain stimulation can treat drug-resistant focal seizures but rarely leads to seizure freedom. Ongoing brain stimulation is typically thought necessary to provide therapeutic effect. We present a patient that achieved seizure freedom after several months of brain stimulation. The patient has maintained seizure freedom for over three years following inadvertent cessation of brain stimulation. This case suggests the possibility that brain stimulation can permanently modulate neural circuitry.
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