Velasco Ana Luisa, Velasco Francisco, Velasco Marcos, Trejo David, Castro Guillermo, Carrillo-Ruiz José Damián
Unit of Stereotactic, Functional Neurosurgery and Radiosurgery, Hospital General de México. Mexico City, Mexico.
Epilepsia. 2007 Oct;48(10):1895-903. doi: 10.1111/j.1528-1167.2007.01181.x. Epub 2007 Jul 18.
Our aim was to evaluate the safety and efficacy of electrical stimulation of the hippocampus in a long-term follow-up study, as well as its impact on memory performance in the treatment of patients with refractory mesial temporal lobe epilepsy.
Nine patients were included. All had refractory partial complex seizures, some with secondary generalizations. All patients had a 3-month-baseline-seizure count, after which they underwent bilateral hippocampal diagnostic electrode implantation to establish focus laterality and location. Three patients had bilateral, and six, unilateral foci. Diagnostic electrodes were explanted and definitive Medtronic electrodes were implanted directed into the hippocampal foci. Position was confirmed with MRI and afterwards, the deep brain stimulation system internalized. Patients signed the informed consent approved by the Hospital's Ethics Committee and began a double-blind stimulation protocol. Patients attended a medical appointment every 3 months for seizure diary collection, deep brain stimulation system checkup, and neuropsychological testing.
Follow-up ranged from 18 months to 7 years. Patients were divided in two groups: five had normal MRIs and seizure reduction of >95%, while four had hippocampal sclerosis and seizure reduction of 50-70%. No patient had neuropsychological deterioration, nor did any patient show side effects. Three patients were explanted after 2 years due to skin erosion in the trajectory of the system.
Electrical stimulation of the hippocampus provides a nonlesional method that improves seizure outcome without memory deterioration in patients with hippocampal epileptic foci.
我们的目的是在一项长期随访研究中评估海马体电刺激的安全性和有效性，以及其对难治性内侧颞叶癫痫患者记忆表现的影响。
纳入9例患者。所有患者均为难治性部分性复杂发作，部分伴有继发性全身性发作。所有患者均有3个月的基线发作计数，之后接受双侧海马诊断电极植入以确定病灶的侧别和位置。3例患者有双侧病灶，6例有单侧病灶。诊断电极被取出，将美敦力确定性电极植入海马病灶。通过磁共振成像确认位置，然后将深部脑刺激系统植入体内。患者签署了经医院伦理委员会批准的知情同意书，并开始双盲刺激方案。患者每3个月就诊一次，以收集发作日记、检查深部脑刺激系统并进行神经心理学测试。
随访时间为18个月至7年。患者分为两组：5例磁共振成像正常，发作减少>95%，4例有海马硬化，发作减少50-70%。没有患者出现神经心理学恶化，也没有患者出现副作用。3例患者在2年后因系统轨迹处皮肤糜烂而取出电极。
海马体电刺激为海马癫痫病灶患者提供了一种非侵入性方法，可改善癫痫发作结果且不会导致记忆衰退。
