Velasco F, Velasco M, Jiménez F, Velasco A L, Brito F, Rise M, Carrillo-Ruiz J D
Stereotactic and Functional Neurosurgery Unit, General Hospital of México, México City.
Neurosurgery. 2000 Aug;47(2):295-304; discussion 304-5. doi: 10.1097/00006123-200008000-00007.
To evaluate the efficacy of chronic electrical stimulation of centromedian thalamic nuclei (ESCM) in the treatment of difficult-to-control seizures.
Thirteen patients underwent ESCM for periods ranging from 12 to 94 months (mean, 41.2 mo) with electrodes stereotactically placed in both centromedian nuclei and connected to internalized stimulation systems. Electrode placement was guided by ventriculography and confirmed with magnetic resonance imaging before stimulation systems were internalized. Anatomic and electrophysiological confirmation of the electrodes' position was accomplished by plotting electrode position on anatomic sections of Schaltenbrand and Bailey's atlas, and testing cortical recruiting responses and electroencephalogram desynchronization elicited by acute low- or high-frequency stimulation, respectively.
Improvement was highly significant for generalized tonicoclonic seizures and atypical absences. Better results were obtained for Lennox-Gastaut syndrome. These results were accompanied by a significant decrease in generalized spike-wave and secondary synchronous discharges, as well as focal spikes in the frontal regions. In contrast, ESCM reduced neither complex partial seizures nor focal spikes in temporal regions. Outcomes using ESCM for generalized epilepsy were better in patients in whom anatomic and electrophysiological confirmation of electrode placement was correct than in those in whom the target was missed bilaterally (P < 0.001). The effect was sustained during the observation period and was better for longer-term than for shorter-term stimulation periods.
ESCM is an efficient and safe procedure for controlling certain seizure types, if patient selection and stereotactic placement are satisfactory.
评估慢性丘脑中央中核电刺激（ESCM）治疗难治性癫痫发作的疗效。
13例患者接受了ESCM治疗，治疗时间为12至94个月（平均41.2个月），电极通过立体定向放置在双侧丘脑中央中核，并连接至植入式刺激系统。在植入刺激系统之前，脑室造影引导电极放置，并通过磁共振成像进行确认。通过将电极位置标绘在Schaltenbrand和Bailey图谱的解剖切片上，并分别测试急性低频或高频刺激引发的皮质募集反应和脑电图去同步化，完成电极位置的解剖学和电生理学确认。
全身性强直阵挛发作和非典型失神发作有显著改善。Lennox-Gastaut综合征患者的效果更好。这些结果伴随着全身性棘波和继发性同步放电以及额叶局灶性棘波的显著减少。相比之下，ESCM既不能减少复杂部分性发作，也不能减少颞叶局灶性棘波。对于全身性癫痫，电极放置的解剖学和电生理学确认正确的患者使用ESCM的效果优于双侧靶点未命中的患者（P < 0.001）。在观察期内效果持续存在，长期刺激期的效果优于短期刺激期。
如果患者选择和立体定向放置满意，ESCM是控制某些癫痫发作类型的一种有效且安全的方法。
