Akamatsu Naoki
Department of Neurology, University of Occupational and Environmental Health School of Medicine.
Rinsho Shinkeigaku. 2005 Nov;45(11):928-30.
The antiepileptic medication and surgical treatment had brought many patients with epilepsy to be seizure free, however, one third of the patients continue to experience seizures. There has recently been an explosion of research into brain stimulation for treating these intractable epilepsy patients. This is largely due to the success of deep brain stimulation of movement disorders. The intelligent cardiac pacemakers also stimulated the neurosurgeons to utilize the implantable devices. In this paper, brain stimulations with vagus nerve stimulator (VNS), depth electrodes, subdural electrodes, external responsive neuro-stimulator, implantable brain stimulator and transcranial magnetic stimulator are reviewed. The VNS had been approved in Europe and United States for clinical use. The efficacy of the VNS has already proven by the controlled trials. Stimulation of the thalamus, subthalamic nucleus and hippocampus showed some efficacy in a small number of patients, however, large scale traials remains to be undertaken. External responsive neurostimulator has shown efficacy and safety to justify further studies with implantable brain stimulators. The multi-center cooperative study is ongoing in the US to examine the usefulness of the implantable stimulator. Animal studies showed efficacy of the transcranial magnetic stimulation for the treatment and prevention of the seizures and status epilepticus.
抗癫痫药物和手术治疗已使许多癫痫患者不再发作，然而，仍有三分之一的患者继续遭受癫痫发作。最近，针对这些难治性癫痫患者的脑刺激研究激增。这主要归因于深部脑刺激治疗运动障碍的成功。智能心脏起搏器也促使神经外科医生利用可植入设备。本文综述了迷走神经刺激器（VNS）、深度电极、硬膜下电极、外部响应神经刺激器、可植入脑刺激器和经颅磁刺激器的脑刺激情况。VNS已在欧洲和美国获批用于临床。VNS的疗效已通过对照试验得到证实。刺激丘脑、丘脑底核和海马体在少数患者中显示出一定疗效，然而，仍有待进行大规模试验。外部响应神经刺激器已显示出疗效和安全性，可为进一步研究可植入脑刺激器提供依据。美国正在进行多中心合作研究，以检验可植入刺激器的效用。动物研究表明经颅磁刺激对癫痫发作和癫痫持续状态的治疗及预防有效。
