Invasive neuromodulation for epilepsy: Comparison of multiple approaches from a single center.
Invasive neuromodulation for epilepsy: Comparison of multiple approaches from a single center.
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DOI：
10.1016/j.yebeh.2022.108951
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发表时间：
2022-12
影响因子：
2.6
通讯作者：
Lundstrom, Brian N.
中科院分区：
文献类型：
--
作者：
Alcala-Zermeno, Juan Luis;Gregg, Nicholas M.;Starnes, Keith;Mandrekar, Jayawant N.;Gompel, Jamie J. Van;Miller, Kai;Worrell, Greg;Lundstrom, Brian N.
关键词：
不适合癫痫手术的耐药性癫痫（DRE）患者可以从神经刺激中获益。很少有数据比较不同的神经调节策略。比较用于治疗DRE的五种有创神经调节策略：丘脑前核脑深部刺激（ANT-DBS）、丘脑中央核DBS（CM-DBS）、反应性神经刺激（RNS）、慢性阈下刺激（CSS）和迷走神经刺激（VNS）。2004-2021年植入有创神经调节的患者的单中心回顾性审查和电话调查。N=159（ANT-DBS=38，CM-DBS=19，RNS=30，CSS=32，VNS=40）。整个队列（IQR 5-90）的总中位癫痫发作减少（MSR）为61%，按降序排列：CSS（85%）、CM-DBS（63%）、ANT-DBS（52%）、RNS（50%）和VNS（50%）; p=0.07。中位随访时间为26个月后，应答率为60%。癫痫发作严重程度、生活满意度和睡眠质量均有所改善。与皮质下刺激（ANT-DBS、CM-DBS和VNS）相比，皮质刺激（RNS和CSS）可改善癫痫发作减少（67% vs. 52%）。局灶性癫痫与全身性癫痫、闭环与开环刺激、儿童与成人病例以及高频（>100 Hz）与低频（<100 Hz）刺激设置的有效性相似。每小时输送的电荷在不同方法中差异很大，但与癫痫发作减少的改善无关。多种侵入性神经调节方法可用于治疗DRE，但很少有证据比较这些方法。本研究采用统一方法获得单中心结果，并代表了比较神经调节方法的努力。
Drug resistant epilepsy (DRE) patients not amenable to epilepsy surgery can benefit from neurostimulation. Few data compare different neuromodulation strategies. Compare five invasive neuromodulation strategies for treatment of DRE: anterior thalamic nuclei deep brain stimulation (ANT-DBS), centromedian thalamic nuclei DBS (CM-DBS), responsive neurostimulation (RNS), chronic subthreshold stimulation (CSS), and vagus nerve stimulation (VNS). Single center retrospective review and phone survey for patients implanted with invasive neuromodulation for 2004–2021. N=159 (ANT-DBS=38, CM-DBS=19, RNS=30, CSS=32, VNS=40). Total median seizure reduction (MSR) was 61% for the entire cohort (IQR 5–90) and in descending order: CSS (85%), CM-DBS (63%), ANT-DBS (52%), RNS (50%), and VNS (50%); p=0.07. Responder rate was 60% after median follow-up time of 26 months. Seizure severity, life satisfaction and quality of sleep were improved. Cortical stimulation (RNS and CSS) was associated with improved seizure reduction compared to subcortical stimulation (ANT-DBS, CM-DBS, and VNS) (67% vs. 52%). Effectiveness was similar for focal epilepsy vs generalized epilepsy, closed loop vs open loop stimulation, pediatric vs. adult cases, and high frequency (>100 Hz) vs low frequency (<100 Hz) stimulation settings. Delivered charge per hour varied widely across approaches but was not correlated with improved seizure reduction. Multiple invasive neuromodulation approaches are available for treatment of DRE but little evidence compares the approaches. This study used a uniform approach for single center results and represents an effort to compare neuromodulation approaches.
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