Akamatsu Naoki, Tsuji Sadatoshi
Department of Neurology, University of Occupational and Environmental Health School of Medicine, Yahatanishi-ku, Kitakyushu, Japan.
Brain Nerve. 2011 Apr;63(4):365-9.
Despite the advances in pharmacologic treatments for epilepsy, approximately one-third of patients with epilepsy continue to have seizures, and alternative treatment approaches are necessary in such cases. For many patients, resective surgery can be an alternative for achieving seizure freedom; however, its success depend on identifying seizure foci before surgery. Many patients with medically intractable epilepsy are not suitable candidates for surgery. The therapeutic effect of electrical stimulation on the brain has been studied for decades. Currently, the thalamus, subthalamic nucleus, hippocampus, cerebellar nuclei, and cortical seizure foci are stimulated for treating epilepsy. In 2010, the results of the first, multicenter randomized double-blinded controlled study were published. This report documents a clinical trial involving stimulation of the anterior nucleus of the thalamus for epilepsy (SANTE). These results showed bilateral stimulation of the anterior nucleus of the thalamus reduces seizures. The responsive neurostimulator, which can be called a brain pacemaker, is another stimulation device for the treatment of epilepsy. A clinical trial involving the Neuropace system is in progress in the USA. Preliminary results indicating the efficacy of the Neuropace study were presented at the annual American Epilepsy Society meeting in 2010; the final results of this study are awaited.
尽管癫痫的药物治疗取得了进展，但仍有大约三分之一的癫痫患者继续发作，在这种情况下需要采用其他治疗方法。对许多患者来说，切除性手术可以作为实现无癫痫发作的一种选择；然而，其成功与否取决于在手术前确定癫痫病灶。许多药物难治性癫痫患者并不适合进行手术。对大脑进行电刺激的治疗效果已经研究了几十年。目前，刺激丘脑、丘脑底核、海马体、小脑核和皮质癫痫病灶来治疗癫痫。2010年，首个多中心随机双盲对照研究结果发表。该报告记录了一项针对癫痫的丘脑前核刺激（SANTE）的临床试验。这些结果表明，双侧刺激丘脑前核可减少癫痫发作。反应性神经刺激器，也可称为脑起搏器，是另一种用于治疗癫痫的刺激装置。美国正在进行一项涉及Neuropace系统的临床试验。2010年在美国癫痫学会年会上公布了表明Neuropace研究有效性的初步结果；该研究的最终结果有待公布。
