Mesial temporal resection following long-term ambulatory intracranial EEG monitoring with a direct brain-responsive neurostimulation system
Mesial temporal resection following long-term ambulatory intracranial EEG monitoring with a direct brain-responsive neurostimulation system
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DOI：
10.1111/epi.16442
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发表时间：
2020-02-18
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：
Hirsch, Lawrence J.;Mirro, Emily A.;Morrell, Martha J.
目的 根据直接脑反应神经刺激器 (RNS) 系统的慢性动态颅内脑电图 (ICEEG) 数据，描述有双侧内侧颞叶 (MTL) 癫痫发作证据并接受 MTL 切除术的医学难治性癫痫患者的癫痫结果。 方法 我们回顾性地确定了 17 个癫痫中心的所有 MTL 癫痫患者，这些患者使用双侧 MTL 导联接受 RNS 系统治疗，其中随后进行了 MTL 切除术。将基于常规术前方法的假定偏侧化与 RNS 系统慢性动态 ICEEG 记录确定的偏侧化进行比较。主要结局是 MTL 切除后最后 3 个月随访时的致残性癫痫发作频率与 MTL 切除前 3 个月的癫痫发作频率相比。 结果 我们确定了 157 名因推测双颞叶癫痫而使用双侧 MTL 导联接受 RNS 系统治疗的患者。 25 名患者 (16%) 随后根据慢性门诊 ICEEG 通知进行了 MTL 切除术（平均 = 42 个月 ICEEG）；对 24 名患者进行了随访。 MTL 切除后，最后一次随访时致残性癫痫发作的中位减少率为 100%（平均值：94%；范围：50%-100%）。 9 名患者 (38%) 仅有慢性动态 ICEEG 记录的单侧电图癫痫发作，所有患者在 MTL 切除后最后一次随访时均无癫痫发作；九人中有八人继续 RNS 系统治疗。 15 名患者 (62%) 患有双侧 MTL 电图癫痫发作，在更活跃的一侧进行了 MTL 切除，继续 RNS 系统治疗，并在最后一次随访时实现中位临床癫痫发作减少 100%（平均值：90%；范围：50%-100%），其中 15 名患者中有 8 名没有癫痫发作。对于随访时间超过 1 年的患者 (N = 21)，15 名患者 (71%) 在最近一年内没有癫痫发作，包括全部 8 名单侧发作患者和 13 名双侧发作患者中的 7 名 (54%)。 意义 慢性动态 ICEEG 数据提供了有关 MTL 癫痫发作侧化的信息，并可以识别可能受益于 MTL 切除的其他患者。
Objective To describe seizure outcomes in patients with medically refractory epilepsy who had evidence of bilateral mesial temporal lobe (MTL) seizure onsets and underwent MTL resection based on chronic ambulatory intracranial EEG (ICEEG) data from a direct brain-responsive neurostimulator (RNS) system.Methods We retrospectively identified all patients at 17 epilepsy centers with MTL epilepsy who were treated with the RNS System using bilateral MTL leads, and in whom an MTL resection was subsequently performed. Presumed lateralization based on routine presurgical approaches was compared to lateralization determined by RNS System chronic ambulatory ICEEG recordings. The primary outcome was frequency of disabling seizures at last 3-month follow-up after MTL resection compared to seizure frequency 3 months before MTL resection.Results We identified 157 patients treated with the RNS System with bilateral MTL leads due to presumed bitemporal epilepsy. Twenty-five patients (16%) subsequently had an MTL resection informed by chronic ambulatory ICEEG (mean = 42 months ICEEG); follow-up was available for 24 patients. After MTL resection, the median reduction in disabling seizures at last follow-up was 100% (mean: 94%; range: 50%-100%). Nine patients (38%) had exclusively unilateral electrographic seizures recorded by chronic ambulatory ICEEG and all were seizure-free at last follow-up after MTL resection; eight of nine continued RNS System treatment. Fifteen patients (62%) had bilateral MTL electrographic seizures, had an MTL resection on the more active side, continued RNS System treatment, and achieved a median clinical seizure reduction of 100% (mean: 90%; range: 50%-100%) at last follow-up, with eight of fifteen seizure-free. For those with more than 1 year of follow-up (N = 21), 15 patients (71%) were seizure-free during the most recent year, including all eight patients with unilateral onsets and 7 of 13 patients (54%) with bilateral onsets.Significance Chronic ambulatory ICEEG data provide information about lateralization of MTL seizures and can identify additional patients who may benefit from MTL resection.