Coley E, Farhadi R, Lewis S, Whittle I R
Dept Clinical Neurosciences, University of Edinburgh, Western General Hospital, Edinburgh, Scotland, UK.
Br J Neurosurg. 2009 Apr;23(2):179-83. doi: 10.1080/02688690802673197.
Deep Brain Stimulation (DBS) for neuromodulation is now commonplace. However little is known about the incidence of either procedural related seizures or epilepsy following chronic DBS. This study aims to provide estimates of these complications for movement disorders, pain and psychiatric conditions. A literature review was performed. Because searches using the terms seizure, epilepsy, and deep brain stimulation revealed only papers dealing with experimental and clinical application of DBS to treat chronic seizures disorders, a search strategy trawling through papers that described clinical case series of DBS was used. Thirty-two papers were reviewed that described stereotactic placement of DBS electrodes for movement disorders, pain syndromes and psychiatric conditions with cohorts of n > 5. Sixteen of these papers describing at least 1418 DBS electrode placements in 1254 patients did not mention seizures as a complication (i.e., it was not possible to know whether seizures had or had not occurred). In 16 papers, describing at least 2101 electrode placements in 1555 patients, seizures were described in 42 patients (incidence 2.7%). The range of seizure incidence varied from 0% (three series encompassing 317 patients and 576 electrode placements) up to 10% (n = 130) and 13% (n = 15). The reasons for this variance were not obvious. At least 74% of seizures occurred around the time of electrode implantation and many of these patients also suffered intracranial hemorrhage. Follow up times were variable (range 6 mths to 5 years). The analysis was complicated by multiple publications from some centres with duplication of some data. The quality of literature on seizures following DBS insertion for neuromodulation is highly variable. Analysis of the available data, after making corrections for publication of duplicate data, suggests strongly that the risk of seizures associated with DBS placement is probably lower than 2.4% (95% CI 1.7 to 3.3 %). The risk of postprocedural seizures associated with chronic deep brain stimulation is even lower with best estimates around 0.5% (95% CI .02 to 1.0%).
用于神经调节的深部脑刺激（DBS）如今已很常见。然而，对于慢性DBS术后与手术相关的癫痫发作或癫痫的发生率却知之甚少。本研究旨在提供运动障碍、疼痛和精神疾病中这些并发症的发生率估计。进行了文献综述。由于使用“癫痫发作”“癫痫”和“深部脑刺激”等术语进行搜索仅发现了关于DBS治疗慢性癫痫疾病的实验和临床应用的论文，因此采用了一种在描述DBS临床病例系列的论文中进行全面搜索的策略。审查了32篇描述DBS电极立体定向放置用于运动障碍、疼痛综合征和精神疾病且队列人数n>5的论文。其中16篇论文描述了在1254例患者中至少进行了1418次DBS电极植入，但未提及癫痫发作作为并发症（即无法知道癫痫发作是否发生）。在另外16篇描述在1555例患者中至少进行了2101次电极植入的论文中，有42例患者出现癫痫发作（发生率2.7%）。癫痫发作发生率的范围从0%（三个系列，共317例患者和576次电极植入）到10%（n=130）和13%（n=15）不等。这种差异的原因并不明显。至少74%的癫痫发作发生在电极植入前后，而且这些患者中有许多还发生了颅内出血。随访时间各不相同（范围为6个月至5年）。由于一些中心的多篇重复发表以及部分数据的重复，分析变得复杂。关于神经调节性DBS植入术后癫痫发作的文献质量差异很大。在对重复数据的发表进行校正后，对现有数据的分析强烈表明，与DBS植入相关的癫痫发作风险可能低于2.4%（95%可信区间1.7%至3.3%）。与慢性深部脑刺激相关的术后癫痫发作风险甚至更低，最佳估计约为0.5%（95%可信区间0.02%至1.0%）。
