Toward rational design of electrical stimulation strategies for epilepsy control.
Toward rational design of electrical stimulation strategies for epilepsy control.
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DOI：
10.1016/j.yebeh.2009.10.017
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发表时间：
2010-01
期刊：
影响因子：
--
通讯作者：
Bikson M
中科院分区：
文献类型：
--
作者：
Sunderam S;Gluckman B;Reato D;Bikson M
电刺激正在成为一种可行的替代癫痫患者的癫痫发作不能缓解药物或手术。它的吸引力是动作的时间和空间特异性，波形参数和时间的灵活性，以及其效果与切除手术不同是可逆的。然而，尽管我们对神经电刺激机制的理解取得了重大进展，但癫痫发作的临床电疗在很大程度上依赖于参数和协议的经验调整。我们强调并发治疗目标与潜在冲突的设计约束，必须解决制定合理的策略癫痫电疗时：即癫痫发作减少与认知障碍，刺激疗效与组织安全性，和机械的洞察力与临床实用主义。首先，从临床角度讨论了与癫痫电刺激相关的治疗标志物、目标和指标。然后提出了实验的观点，开环电刺激的生物物理机制和模式，以及闭环控制癫痫的潜在好处。
Electrical stimulation is emerging as a viable alternative for epilepsy patients whose seizures are not alleviated by drugs or surgery. Its attractions are temporal and spatial specificity of action, flexibility of waveform parameters and timing, and the perception that its effects are reversible unlike resective surgery. However, despite significant advances in our understanding of mechanisms of neural electrical stimulation, clinical electrotherapy for seizures relies heavily on empirical tuning of parameters and protocols. We highlight concurrent treatment goals with potentially conflicting design constraints that must be resolved when formulating rational strategies for epilepsy electrotherapy: namely seizure reduction versus cognitive impairment, stimulation efficacy versus tissue safety, and mechanistic insight versus clinical pragmatism. First, treatment markers, objectives, and metrics relevant to electrical stimulation for epilepsy are discussed from a clinical perspective. Then the experimental perspective is presented, with the biophysical mechanisms and modalities of open-loop electrical stimulation, and the potential benefits of closed-loop control for epilepsy.
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