Electrical stimulation of the anterior nucleus of thalamus for treatment of refractory epilepsy
Electrical stimulation of the anterior nucleus of thalamus for treatment of refractory epilepsy
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DOI：
10.1111/j.1528-1167.2010.02536.x
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发表时间：
2010-05-01
期刊：
影响因子：
5.6
通讯作者：
Graves, Nina
中科院分区：
文献类型：
--
作者：
Fisher, Robert;Salanova, Vicenta;Graves, Nina
目的：我们报道一项针对与脑定位相关的癫痫进行的丘脑前核双侧刺激的多中心、双盲、随机试验。
方法：参与者为患有药物难治性部分性发作（包括继发性全身性发作）的成年人。在3个月的盲法阶段，一半接受刺激，一半不接受刺激；然后所有参与者都接受非盲法刺激。
结果：110名参与者被随机分组。基线每月发作频率中位数为19.5次。在盲法阶段的最后一个月，根据广义估计方程（GEE）模型估计，刺激组发作减少的程度比对照组高29%（p = 0.002）。在盲法阶段结束时，未调整的中位数下降情况为对照组14.5%，刺激组40.4%。刺激显著减少了复杂部分性发作和“最严重”的发作。到2年时，发作频率中位数降低了56%；54%的患者发作减少至少50%，14名患者至少6个月无发作。发生了5例死亡，但均非由植入或刺激导致。没有参与者出现症状性出血或脑部感染。2名参与者出现急性、短暂的与刺激相关的发作。认知和情绪方面两组无差异，但刺激组的参与者更有可能将抑郁或记忆问题报告为不良事件。
讨论：丘脑前核双侧刺激可减少发作。在2年的研究期间益处持续存在。并发症发生率适中。丘脑前核的深部脑刺激对一些患有药物难治性部分性发作和继发性全身性发作的患者是有用的。
P>Purpose:We report a multicenter, double-blind, randomized trial of bilateral stimulation of the anterior nuclei of the thalamus for localization-related epilepsy.Methods:Participants were adults with medically refractory partial seizures, including secondarily generalized seizures. Half received stimulation and half no stimulation during a 3-month blinded phase; then all received unblinded stimulation.Results:One hundred ten participants were randomized. Baseline monthly median seizure frequency was 19.5. In the last month of the blinded phase the stimulated group had a 29% greater reduction in seizures compared with the control group, as estimated by a generalized estimating equations (GEE) model (p = 0.002). Unadjusted median declines at the end of the blinded phase were 14.5% in the control group and 40.4% in the stimulated group. Complex partial and "most severe" seizures were significantly reduced by stimulation. By 2 years, there was a 56% median percent reduction in seizure frequency; 54% of patients had a seizure reduction of at least 50%, and 14 patients were seizure-free for at least 6 months. Five deaths occurred and none were from implantation or stimulation. No participant had symptomatic hemorrhage or brain infection. Two participants had acute, transient stimulation-associated seizures. Cognition and mood showed no group differences, but participants in the stimulated group were more likely to report depression or memory problems as adverse events.Discussion:Bilateral stimulation of the anterior nuclei of the thalamus reduces seizures. Benefit persisted for 2 years of study. Complication rates were modest. Deep brain stimulation of the anterior thalamus is useful for some people with medically refractory partial and secondarily generalized seizures.