Clinica de Epilepsia de Sao Paulo, Epilepsy Surgery Program, Sao Paulo, SP, Brazil.
Clinica de Epilepsia de Sao Paulo, Epilepsy Surgery Program, Sao Paulo, SP, Brazil.
Seizure. 2014 Jan;23(1):6-9. doi: 10.1016/j.seizure.2013.08.005. Epub 2013 Aug 16.
In this study, we present the results obtained from a series of patients with refractory temporal lobe epilepsy (r-TLE) who underwent hippocampal deep brain stimulation (Hip-DBS).
Nine consecutive adult patients were studied. Low-frequency and high-frequency stimulation was carried out immediately after the insertion of each electrode. Chronic continuous high-frequency stimulation was used during treatment. The mean follow-up time was 30.1 months. The mean age of the patients was 37.2 years. The MRI scan was normal in three patients; four patients had bilateral mesial temporal sclerosis (MTS), and two had unilateral MTS.
The patients with unilateral MTS received unilateral implantation and experienced a 76% and an 80% reduction in seizure frequency after Hip-DBS. All patients with normal MRI scans were implanted bilaterally. Two of these patients received unilateral activation of the electrodes and experienced a 97% and an 80% reduction in seizure frequency; the third patient had bilateral activation of the device and was a non-responder. All patients with bilateral MTS were implanted bilaterally. Three of these patients received unilateral activation of the device and experienced a 66%, a 66% and a 100% reduction in seizure frequency after Hip-DBS; one patient had bilateral electrode activation, and was a non-responder. Whenever present, generalised tonic-clonic seizures disappeared completely after Hip-DBS.
Although performed on a relatively small number of patients, Hip-DBS was safe and effective in our patients with r-TLE. Seven of the nine patients were considered responders. Hip-DBS might represent a useful therapeutic option in patients with refractory temporal lobe epilepsy who were not candidates for resective surgery or have had previous failed procedures.
本研究介绍了一系列接受海马深部脑刺激（Hip-DBS）治疗的难治性颞叶癫痫（r-TLE）患者的结果。
研究了 9 例连续的成年患者。在插入每个电极后立即进行低频和高频刺激。在治疗过程中使用慢性连续高频刺激。平均随访时间为 30.1 个月。患者的平均年龄为 37.2 岁。3 例 MRI 扫描正常，4 例双侧海马内侧硬化（MTS），2 例单侧 MTS。
单侧 MTS 的患者接受单侧植入，Hip-DBS 后癫痫发作频率分别降低了 76%和 80%。所有 MRI 扫描正常的患者均接受双侧植入。其中 2 例患者单侧电极激活，癫痫发作频率分别降低了 97%和 80%；第 3 例患者双侧装置激活，无反应。双侧 MTS 的所有患者均接受双侧植入。其中 3 例患者单侧装置激活，Hip-DBS 后癫痫发作频率分别降低了 66%、66%和 100%；1 例患者双侧电极激活，无反应。Hip-DBS 后，只要存在全身性强直阵挛性发作，就会完全消失。
尽管在相对较少的患者中进行了这项研究，但 Hip-DBS 在我们的 r-TLE 患者中是安全且有效的。9 例患者中有 7 例被认为是有反应者。Hip-DBS 可能是一种有用的治疗选择，适用于不适合手术切除或以前手术失败的难治性颞叶癫痫患者。
