Sleep disruption is not observed with brain-responsive neurostimulation for epilepsy.
Sleep disruption is not observed with brain-responsive neurostimulation for epilepsy.
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大脑反应性神经刺激治疗癫痫未观察到睡眠中断。
DOI：
10.1002/epi4.12382
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发表时间：
2020
期刊：
影响因子：
3
通讯作者：
Rao,VikramR
中科院分区：
文献类型：
--
作者：
Ruoff,Leslie;Jarosiewicz,Beata;Zak,Rochelle;Tcheng,ThomasK;Neylan,ThomasC;Rao,VikramR
目的向神经系统传递电脉冲的神经刺激装置广泛用于治疗难治性癫痫患者的癫痫发作，但这些疗法对睡眠的影响尚不完全清楚。迷走神经刺激可导致阻塞性睡眠呼吸暂停，丘脑深部脑刺激可导致睡眠中断。脑反应性神经刺激装置（RNS®系统，NeuroPace, Inc）在临床试验中耐受性良好，但对睡眠的潜在影响尚不清楚。方法六名患有医学难治性局灶性癫痫的成人接受 RNS 系统治疗至少六个月，接受了一晚的多导睡眠图 (PSG)。 RNS 系统引导位置包括内侧颞叶和新皮质目标。根据标准指南对睡眠阶段和觉醒进行评分。 RNS 系统响应检测到的癫痫样活动而提供的刺激通过头皮脑电图上的伪影进行识别。结果由于与 PSG 期间 EEG 上刺激伪影的不可靠识别相关的技术原因，一名受试者被排除在外。其余 5 名受试者的 PSG 表现出睡眠不完整且频繁觉醒。与刺激对齐的唤醒直方图显示刺激前唤醒的显着峰值。其中一名受试者的觉醒峰值在刺激前开始，并在刺激后延长约 1 秒。没有观察到仅在刺激后出现的觉醒峰值。意义在这一小群患者中，大脑反应性神经刺激似乎不会扰乱睡眠。如果在更大规模的研究中得到证实，这可能代表脑响应神经刺激相对于其他神经刺激方式的潜在临床优势。
ObjectiveNeurostimulation devices that deliver electrical impulses to the nervous system are widely used to treat seizures in patients with medically refractory epilepsy, but the effects of these therapies on sleep are incompletely understood. Vagus nerve stimulation can contribute to obstructive sleep apnea, and thalamic deep brain stimulation can cause sleep disruption. A device for brain‐responsive neurostimulation (RNS®System, NeuroPace, Inc) is well tolerated in clinical trials, but potential effects on sleep are unknown.MethodsSix adults with medically refractory focal epilepsy treated for at least six months with the RNS System underwent a single night of polysomnography (PSG). RNS System lead locations included mesial temporal and neocortical targets. Sleep stages and arousals were scored according to standard guidelines. Stimulations delivered by the RNS System in response to detections of epileptiform activity were identified by artifacts on scalp electroencephalography.ResultsOne subject was excluded for technical reasons related to unreliable identification of stimulation artifact on EEG during PSG. In the remaining five subjects, PSG showed fragmented sleep with frequent arousals. Arousal histograms aligned to stimulations revealed a significant peak in arousals just before stimulation. In one of these subjects, the arousal peak began before stimulation and extended ~1 seconds after stimulation. A peak in arousals occurring only after stimulation was not observed.SignificanceIn this small cohort of patients, brain‐responsive neurostimulation does not appear to disrupt sleep. If confirmed in larger studies, this could represent a potential clinical advantage of brain‐responsive neurostimulation over other neurostimulation modalities.