Deep brain stimulation in patients with refractory temporal lobe epilepsy
Deep brain stimulation in patients with refractory temporal lobe epilepsy
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DOI：
10.1111/j.1528-1167.2007.01005.x
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发表时间：
2007-08-01
期刊：
影响因子：
5.6
通讯作者：
Van Roost, Dirk
中科院分区：
文献类型：
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作者：
Boon, Paul;Vonck, Kristl;Van Roost, Dirk
目的：本先导性研究前瞻性地评估了长期脑深部电刺激（DBS）在内侧颞叶（MTL）结构的疗效与MTL epilepsy.Methods：12例连续难治性MTL癫痫患者被纳入本研究。该方案包括有创视频脑电图监测发作发作定位和评估随后的刺激发作区。副作用和癫痫发作频率的变化进行了仔细monitored.Results：12例患者中有10例接受了长期MTL DBS。12例患者中2例接受选择性杏仁核切除术。平均随访31个月后（范围，12-52个月），10例刺激患者中有1例无癫痫发作（> 1年），10例患者中有1例发作频率减少>90%，10例患者中有5例发作频率减少>50%，10例患者中有2例发作频率减少30-49%; 10个病人中有一个是无应答者。没有患者报告副作用。在1例患者中，MRI显示沿DBS电极轨迹沿着存在无症状颅内血管扩张。所有患者的临床神经学检查均未出现变化。接受选择性杏仁核campectomy的患者是无创伤的（> 1年），抗癫痫药物是不变的，没有副作用had occurred.Conclusions：这项开放的试点研究表明，长期DBS在MTL结构的潜在疗效，现在应该进一步证实了多中心随机对照试验。
Purpose: This pilot study prospectively evaluated the efficacy of long-term deep brain stimulation (DBS) in medial temporal lobe (MTL) structures in patients with MTL epilepsy.Methods: Twelve consecutive patients with refractory MTL epilepsy were included in this study. The protocol included invasive video-EEG monitoring for ictal-onset localization and evaluation for subsequent stimulation of the ictal-onset zone. Side effects and changes in seizure frequency were carefully monitored.Results: Ten of 12 patients underwent long-term MTL DBS. Two of 12 patients underwent selective amygdalohippocampectomy. After mean follow-up of 31 months (range, 12-52 months), one of 10 stimulated patients are seizure free (> 1 year), one of 10 patients had a >90% reduction in seizure frequency; five of 10 patients had a seizure-frequency reduction of >50%; two of 10 patients had a seizure-frequency reduction of 30-49%; and one of 10 patients was a nonresponder. None of the patients reported side effects. In one patient, MRI showed asymptomatic intracranial hemorrhages along the trajectory of the DBS electrodes. None of the patients showed changes in clinical neurological testing. Patients who underwent selective amygdalohippocampectomy are seizure-free (> 1 year), AEDs are unchanged, and no side effects have occurred.Conclusions: This open pilot study demonstrates the potential efficacy of long-term DBS in MTL structures that should now be further confirmed by multicenter randomized controlled trials.