Chronic deep brain stimulation in mesial temporal lobe epilepsy
Chronic deep brain stimulation in mesial temporal lobe epilepsy
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DOI：
10.1016/j.seizure.2011.03.001
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发表时间：
2011-07-01
影响因子：
3
通讯作者：
Pollo, Claudio
中科院分区：
文献类型：
--
作者：
Boex, Colette;Seeck, Margitta;Pollo, Claudio
本研究的目的是评价慢性杏仁核-海马脑深部电刺激（AH-DBS）治疗内侧颞叶癫痫（TLE）的效率和参数变化的影响。（130 Hz，随访12-24个月）：2例海马硬化（HS）患者和6例非病灶性近中TLE（NLES）患者。研究了逐步增加强度（0-Off至2 V）和刺激配置（四极和双极）对癫痫发作频率和神经心理学表现的影响。两名HS患者在高压双极DBS（>= 1 V）或四极刺激下癫痫发作频率显著降低（65-75%）。6例NLES患者中有2例无神经纤维瘤，其中1例无刺激，提示微损伤效应。两名NLES患者的癫痫发作频率降低（65-70%），而其余两名患者的癫痫发作没有明显减少。神经心理学评估显示，两名患者在强刺激下出现可逆性记忆障碍。AH-DBS对大多数TLE患者显示出长期有效性。对于患有耐药性癫痫且不适合切除手术的患者来说，这是一种有价值的治疗选择。刺激参数变化的影响表明，HS患者需要较大的刺激区域，而NLES患者则需要有限的刺激区域或甚至微小病变效应，电极接近致痫区的重要性仍有待研究。需要进一步研究以确定后一种意见。(C)2011年英国癫痫协会。由爱思唯尔有限公司出版。保留所有权利。
The objective of this study was to evaluate the efficiency and the effects of changes in parameters of chronic amygdala-hippocampal deep brain stimulation (AH-DBS) in mesial temporal lobe epilepsy (TLE).Eight pharmacoresistant patients, not candidates for ablative surgery, received chronic AH-DBS (130 Hz, follow-up 12-24 months): two patients with hippocampal sclerosis (HS) and six patients with non-lesional mesial TLE (NLES). The effects of stepwise increases in intensity (0-Off to 2 V) and stimulation configuration (quadripolar and bipolar), on seizure frequency and neuropsychological performance were studied.The two HS patients obtained a significant decrease (65-75%) in seizure frequency with high voltage bipolar DBS (>= 1 V) or with quadripolar stimulation. Two out of six NLES patients became seizure-free, one of them without stimulation, suggesting a microlesional effect. Two NLES patients experienced reductions of seizure frequency (65-70%), whereas the remaining two showed no significant seizure reduction. Neuropsychological evaluations showed reversible memory impairments in two patients under strong stimulation only.AH-DBS showed long-term efficiency in most of the TLE patients. It is a valuable treatment option for patients who suffer from drug resistant epilepsy and who are not candidates for resective surgery. The effects of changes in the stimulation parameters suggest that a large zone of stimulation would be required in HS patients, while a limited zone of stimulation or even a microlesional effect could be sufficient in NLES patients, for whom the importance of the proximity of the electrode to the epileptogenic zone remains to be studied. Further studies are required to ascertain these latter observations. (C) 2011 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.