Seizure outcome during bilateral, continuous, thalamic centromedian nuclei deep brain stimulation in patients with generalized epilepsy: a prospective, open-label study
Seizure outcome during bilateral, continuous, thalamic centromedian nuclei deep brain stimulation in patients with generalized epilepsy: a prospective, open-label study
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DOI：
10.1016/j.seizure.2020.08.028
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发表时间：
2020-10-01
影响因子：
3
通讯作者：
Mariani, Pedro Paulo
中科院分区：
文献类型：
--
作者：
Cukiert, Arthur;Cukiert, Cristine Mella;Mariani, Pedro Paulo
目的：我们报告的癫痫发作频率和注意力的结果在丘脑正中刺激（CM-DBS）在难治性全身性癫痫（GEhold.Methods）患者：20例连续GE谁提交给CM-DBS，并有至少一年的随访进行了前瞻性研究。CM是双边目标。刺激强度斜升（双极，连续，130 Hz; 300 μ sec），直到4.5 V或直到出现副作用。在术后体积MRI扫描上确定接触者的位置。使用SNAP-IV（Swanson，Nolan和Pelham）问卷对注意力进行定性评估。患者被认为是响应者在CM-DBS期间，如果至少有50%的癫痫发作频率减少相比，baseline.Results：中位年龄为15.5岁（13名男性）。中位随访时间为2.55年。EEG显示所有患者均出现全身棘波和波放电。10例患者MRI正常，6例患者显示弥漫性萎缩，4例患者显示异常（3例患者双侧皮质发育异常，1例患者单侧半球萎缩）。患者每天出现多种癫痫发作类型（每天8至66次;中位数：37次），包括强直性、失张力性、肌阵挛性、非典型失神和全身强直-阵挛性癫痫发作。平均DBS强度为4.3 V。在14例患者中观察到插入效应。CM-DBS能够显著降低强直性（p < 0.001）、非典型失神发作（p < 0.001）、失张力发作（p = 0.001）和双侧全身强直-阵挛发作（p = 0.004）的频率。1例患者无复发。90%的患者被认为是应答者（癫痫发作频率降低>50%）。所有患者的注意力都有所改善。在SNAP-IV问卷中注意到改善的平均项目数为4.8。整体癫痫发作频率降低和注意力改善之间存在显著相关性（p = 0.033）。讨论：该前瞻性开放标签研究包括一个大型同质队列，并提供了CM-DBS在降低癫痫发作负担和增加难治性全身性癫痫患者注意力方面疗效的证据。
Objective: We report on the seizure frequency and attention outcome during thalamic centromedian stimulation (CM-DBS) in patients with refractory generalized epilepsy (GE).Methods: Twenty consecutive patients with GE who were submitted to CM-DBS and had at least one year of follow-up were prospectively studied. The CM was targeted bilaterally. Stimulation intensity was ramped up (bipolar, continuous, 130 Hz; 300 mu sec) until 4.5 V or until side effects developed. Contacts' position was determined on postoperative volumetric MRI scans. Attention was qualitatively evaluated using the SNAP-IV (Swanson, Nolan, and Pelham) questionnaire. Patients were considered responders during CM-DBS if an at least 50% seizure frequency reduction was obtained compared to baseline.Results: Median age was 15.5 years (13 males). Median follow-up time was 2.55 years. EEG disclosed generalized spike-and wave discharges in all patients. MRI was normal in 10 patients, showed diffuse atrophy in 6 patients, and showed abnormalities in 4 patients (3 patients had bilateral cortical development abnormalities and one had unilateral hemispheric atrophy). Patients presented with daily multiple seizure types (8 to 66 per day; median: 37), including tonic, atonic, myoclonic, atypical absence and generalized tonic-clonic seizures. Mean DBS intensity was 4.3 V. An insertional effect was noted in 14 patients. CM-DBS was able to significantly reduce the frequency of tonic (p < 0.001), atypical absence seizures (p < 0.001), atonic seizures (p = 0.001) and bilateral generalized tonic-clonic seizures (p = 0.004). One patient became seizure-free. Ninety percent of the patients were considered responders (>50% seizure frequency reduction). All patients showed some improvement in attention. The mean number of items in which improvement was noted in the SNAP-IV questionnaire was 4.8. There was a significant relationship between overall seizure frequency reduction and improvement of attention (p = 0.033).Discussion: This prospective, open label study included a large, homogeneous cohort and provided evidence on the efficacy of CM-DBS in reducing the seizure burden and increasing attention in patients with refractory generalized epilepsy.