Brain-responsive neurostimulation in patients with medically intractable seizures arising from eloquent and other neocortical areas
Brain-responsive neurostimulation in patients with medically intractable seizures arising from eloquent and other neocortical areas
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DOI：
10.1111/epi.13739
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发表时间：
2017-06-01
期刊：
影响因子：
5.6
通讯作者：
Morrell, Martha J.
中科院分区：
文献类型：
--
作者：
Jobst, Barbara C.;Kapur, Ritu;Morrell, Martha J.
目的评估脑反应性刺激对成人难治性新皮质起源部分性癫痫发作的减少反应和安全性。方法从脑反应性神经刺激器（RNS 系统，NeuroPace）的前瞻性临床试验中筛选出新皮质起源部分性癫痫发作患者。通过评估与植入前基线相比的癫痫发作频率，计算植入后 2-6 年癫痫发作的减少情况。根据报告的不良事件评估安全性。其他分析根据癫痫发作的脑叶和功能区（例如口才皮质）考虑了安全性和癫痫发作减少情况。结果有 126 名患者出现新皮质发作的癫痫发作。平均随访时间为 6.1 年。额叶和顶叶癫痫发作患者的癫痫发作减少中位数百分比为 70%，颞叶新皮质发作患者为 58%，多叶癫痫发作患者为 51%（最后观察结果进行 [LOCF] 分析）。 26% 的患者经历过至少一次 6 个月或更长的无癫痫发作期，14% 的患者经历过至少一次 1 年或更长的无癫痫发作期。磁共振成像（MRI；减少 77%，LOCF）和 MRI 结果正常（减少 45%，LOCF）的患者受益，尽管 MRI 病变患者的治疗反应更为强劲（p=0.02，广义估计方程 [GEE]）。接受过和未接受过癫痫手术或迷走神经刺激的患者的癫痫发作减少情况没有差异。用于治疗的刺激参数不会引起急性或慢性神经功能缺损，即使是在口才皮质区域也是如此。感染率（每位患者植入年 0.017 例）和围手术期出血率（0.8%）不高于其他神经刺激装置。 意义 对于难治性癫痫患者，包括新皮质发作的成人和口语皮质发作的成人，脑反应刺激代表了一种安全有效的治疗选择。
ObjectiveEvaluate the seizure-reduction response and safety of brain-responsive stimulation in adults with medically intractable partial-onset seizures of neocortical origin.MethodsPatients with partial seizures of neocortical origin were identified from prospective clinical trials of a brain-responsive neurostimulator (RNS System, NeuroPace). The seizure reduction over years 2-6 postimplantation was calculated by assessing the seizure frequency compared to a preimplantation baseline. Safety was assessed based on reported adverse events. Additional analyses considered safety and seizure reduction according to lobe and functional area (e.g., eloquent cortex) of seizure onset.ResultsThere were 126 patients with seizures of neocortical onset. The average follow-up was 6.1 implant years. The median percent seizure reduction was 70% in patients with frontal and parietal seizure onsets, 58% in those with temporal neocortical onsets, and 51% in those with multilobar onsets (last observation carried forward [LOCF] analysis). Twenty-six percent of patients experienced at least one seizure-free period of 6months or longer and 14% experienced at least one seizure-free period of 1year or longer. Patients with lesions on magnetic resonance imaging (MRI; 77% reduction, LOCF) and those with normal MRI findings (45% reduction, LOCF) benefitted, although the treatment response was more robust in patients with an MRI lesion (p=0.02, generalized estimating equation [GEE]). There were no differences in the seizure reduction in patients with and without prior epilepsy surgery or vagus nerve stimulation. Stimulation parameters used for treatment did not cause acute or chronic neurologic deficits, even in eloquent cortical areas. The rates of infection (0.017 per patient implant year) and perioperative hemorrhage (0.8%) were not greater than with other neurostimulation devices.SignificanceBrain-responsive stimulation represents a safe and effective treatment option for patients with medically intractable epilepsy, including adults with seizures of neocortical onset, and those with onsets from eloquent cortex.