Department of Neurology, University Hospital of Geneva, CH-1211 Genèva 14, Switzerland.
Epilepsy Res. 2012 Mar;99(1-2):87-93. doi: 10.1016/j.eplepsyres.2011.10.026. Epub 2011 Nov 12.
Deep brain stimulation (DBS) of different nuclei is being evaluated as a treatment for epilepsy. While encouraging results have been reported, the effects of changes in stimulation parameters have been poorly studied. Here the effects of changes of pulse waveform in high frequency DBS (130 Hz) of the amygdala-hippocampal complex (AH) are presented. These effects were studied on interictal epileptic discharge rates (IEDRs). AH-DBS was implemented with biphasic versus pseudo monophasic charge balanced pulses, in two groups of patients: six with temporal lobe epilepsy (TLE) associated with hippocampal sclerosis (HS) and six with non lesional (NLES) temporal epilepsy. In patients with HS, IEDRs were significantly reduced with AH-DBS applied with biphasic pulses in comparison with monophasic pulse. IEDRs were significantly reduced in only two patients with NLES independently to stimulus waveform. Comparison to long-term seizure outcome suggests that IEDRs could be used as a neurophysiological marker of chronic AH-DBS and they suggest that the waveform of the electrical stimuli can play a major role in DBS. We concluded that biphasic stimuli are more efficient than pseudo monophasic pulses in AH-DBS in patients with HS. In patients with NLES epilepsy, other parameters relevant for efficacy of DBS remain to be determined.
深部脑刺激（DBS）不同核团被评估为癫痫的治疗方法。虽然已经报道了令人鼓舞的结果，但刺激参数变化的影响研究甚少。本文介绍了高频 DBS（130 Hz）刺激杏仁核-海马复合体（AH）时脉冲波形变化的影响。这些影响是在发作间期癫痫放电率（IEDR）上进行研究的。采用双相和拟单相平衡电荷脉冲对两组患者进行 AH-DBS：六例伴有海马硬化（HS）的颞叶癫痫（TLE）和六例非病变性（NLES）颞叶癫痫。在 HS 患者中，与单相脉冲相比，双相脉冲的 AH-DBS 应用可显著降低 IEDR。只有两名 NLES 患者的 IEDR 独立于刺激波形而显著降低。与长期癫痫发作结果的比较表明，IEDR 可作为慢性 AH-DBS 的神经生理学标志物，它们表明电刺激的波形在 DBS 中可以发挥重要作用。我们得出结论，在 HS 患者中，双相刺激比拟单相脉冲在 AH-DBS 中更有效。在 NLES 癫痫患者中，DBS 疗效的其他相关参数仍有待确定。
