Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania 19107, USA.
Neurobiol Dis. 2010 Jun;38(3):354-60. doi: 10.1016/j.nbd.2009.07.007. Epub 2009 Jul 23.
Deep brain stimulation for epilepsy has garnered attention from epileptologists due to its well-documented success in treating movement disorders and the low morbidity associated with the implantation of electrodes. Given the large proportion of patients who fail medical therapy and are not candidates for surgical amelioration, as well as the suboptimal seizure control offered by vagus nerve stimulation, the search for appropriate brain structures to serve as targets for deep brain stimulation has generated a useful body of evidence to serve as the basis for larger investigations. Early results of the SANTE trial should lay the foundation for widespread implementation of DBS for epilepsy targeting the anterior thalamic nucleus. Other targets also offer promise, including the caudate nucleus, the subthalamic nucleus, the cerebellum, the centromedian nucleus of the thalamus, and the hippocampus. This paper reviews the logic which underlies these potential targets and recapitulates the current data from limited human trials supporting each one. It also provides a succinct overview of the surgical procedure used for electrode implantation.
深部脑刺激治疗癫痫已引起癫痫学家的关注，因为它在治疗运动障碍方面有充分的文献记录，并且电极植入的发病率较低。鉴于很大一部分患者对药物治疗无效，且不符合手术改善的条件，以及迷走神经刺激提供的癫痫控制效果并不理想，因此寻找合适的大脑结构作为深部脑刺激的靶点，已经产生了大量有用的证据，为进一步的研究提供了基础。SANTE 试验的早期结果应该为广泛实施针对前丘脑核的深部脑刺激治疗癫痫奠定基础。其他靶点也有希望，包括尾状核、丘脑底核、小脑、丘脑中央中核和海马体。本文回顾了这些潜在靶点的基本原理，并总结了目前有限的支持每种靶点的人类试验数据。它还简要概述了用于电极植入的手术过程。
