Dpt Neurology, University Hospital of Geneva, 1211 Geneva 14, Switzerland.
Seizure. 2011 Jul;20(6):485-90. doi: 10.1016/j.seizure.2011.03.001. Epub 2011 Apr 12.
The objective of this study was to evaluate the efficiency and the effects of changes in parameters of chronic amygdala-hippocampal deep brain stimulation (AH-DBS) in mesial temporal lobe epilepsy (TLE). Eight pharmacoresistant patients, not candidates for ablative surgery, received chronic AH-DBS (130 Hz, follow-up 12-24 months): two patients with hippocampal sclerosis (HS) and six patients with non-lesional mesial TLE (NLES). The effects of stepwise increases in intensity (0-Off to 2 V) and stimulation configuration (quadripolar and bipolar), on seizure frequency and neuropsychological performance were studied. The two HS patients obtained a significant decrease (65-75%) in seizure frequency with high voltage bipolar DBS (≥1 V) or with quadripolar stimulation. Two out of six NLES patients became seizure-free, one of them without stimulation, suggesting a microlesional effect. Two NLES patients experienced reductions of seizure frequency (65-70%), whereas the remaining two showed no significant seizure reduction. Neuropsychological evaluations showed reversible memory impairments in two patients under strong stimulation only. AH-DBS showed long-term efficiency in most of the TLE patients. It is a valuable treatment option for patients who suffer from drug resistant epilepsy and who are not candidates for resective surgery. The effects of changes in the stimulation parameters suggest that a large zone of stimulation would be required in HS patients, while a limited zone of stimulation or even a microlesional effect could be sufficient in NLES patients, for whom the importance of the proximity of the electrode to the epileptogenic zone remains to be studied. Further studies are required to ascertain these latter observations.
本研究旨在评估慢性杏仁核-海马深部脑刺激（AH-DBS）参数变化在颞叶癫痫（TLE）中的效率和影响。八位药物难治性患者，不符合手术切除条件，接受了慢性 AH-DBS 治疗（130 Hz，随访 12-24 个月）：两位海马硬化（HS）患者和六位非病变性内侧 TLE（NLES）患者。研究了强度（0-Off 至 2 V）和刺激配置（四极和双极）的逐步增加对发作频率和神经心理学表现的影响。两位 HS 患者在高电压双极 DBS（≥1 V）或四极刺激下，癫痫发作频率显著降低（65-75%）。六位 NLES 患者中有两位无发作，其中一位无刺激，提示存在微病变效应。两位 NLES 患者发作频率降低（65-70%），而另外两位无明显发作减少。神经心理学评估显示，只有在强烈刺激下，才有两位患者出现可逆性记忆障碍。AH-DBS 在大多数 TLE 患者中显示出长期疗效。对于药物难治性癫痫且不符合手术切除条件的患者，它是一种有价值的治疗选择。刺激参数变化的影响表明，HS 患者需要较大的刺激区域，而 NLES 患者可能只需要有限的刺激区域甚至微病变效应，而电极与致痫区的接近程度对于 NLES 患者的重要性仍有待研究。需要进一步的研究来证实这些观察结果。
