Morrell Martha
Stanford University Medical Center, Mountain View, CA 94043, USA.
Curr Opin Neurol. 2006 Apr;19(2):164-8. doi: 10.1097/01.wco.0000218233.60217.84.
Scheduled and responsive direct brain stimulation may be an effective and safe therapy for medically intractable epilepsy.
Scheduled stimulation (open loop) has been provided via electrodes implanted in thalamic nuclei, the cerebellum and the hippocampus using devices commercially available for treatment of tremor and Parkinson's disease. Small pilot trials suggest that seizure frequency is reduced in some patients with intractable epilepsy. Responsive stimulation requires systems that detect abnormal electrographic activity and provide stimulation (closed loop). Studies in inpatients and outpatients suggest that abnormal electrographic discharges can be detected before there is evolution into a clinical seizure, and that focal stimulation of the epileptogenic region terminates electrographic seizures and reduces the frequency of clinically evident seizures.
Direct brain stimulation appears to be safe and may be efficacious in treating medically intractable epilepsy. The optimal location (deep brain or cortical) and characteristics of the stimulation (frequency, current, duration), and whether stimulation should be focal or responsive are still to be determined. If ongoing studies of a deep brain stimulator and of a cranially implanted responsive neurostimulator demonstrate effectiveness, then neurostimulation may become available as adjunctive therapy for medically intractable epilepsy.
计划性和反应性直接脑刺激可能是治疗药物难治性癫痫的一种有效且安全的疗法。
已通过植入丘脑核、小脑和海马体的电极，利用市售用于治疗震颤和帕金森病的设备进行计划性刺激（开环）。小型试点试验表明，一些难治性癫痫患者的癫痫发作频率有所降低。反应性刺激需要能够检测异常脑电图活动并提供刺激的系统（闭环）。对住院患者和门诊患者的研究表明，在演变为临床发作之前就能检测到异常脑电图放电，并且对致痫区域的局灶性刺激可终止脑电图癫痫发作并降低临床明显发作的频率。
直接脑刺激似乎是安全的，并且在治疗药物难治性癫痫方面可能有效。刺激的最佳位置（深部脑区或皮层）、刺激的特征（频率、电流、持续时间）以及刺激应是局灶性还是反应性仍有待确定。如果正在进行的深部脑刺激器和颅骨植入式反应性神经刺激器的研究证明有效，那么神经刺激可能会成为药物难治性癫痫的辅助治疗方法。
