Van Nieuwenhuyse B, Raedt R, Delbeke J, Wadman W J, Boon P, Vonck K
Laboratory for Clinical and Experimental Neurophysiology, Neurobiology, and Neuropsychology, Department of Neurology, Ghent University, Ghent, Belgium.
Laboratory for Clinical and Experimental Neurophysiology, Neurobiology, and Neuropsychology, Department of Neurology, Ghent University, Ghent, Belgium.
Brain Stimul. 2015 Mar-Apr;8(2):192-9. doi: 10.1016/j.brs.2014.11.016. Epub 2014 Dec 4.
In many temporal lobe epilepsy (TLE) patients both hippocampi are seizure onset zones. These patients are unsuitable candidates for epilepsy surgery but may be amenable to hippocampal deep brain stimulation (DBS). The optimal DBS parameters for these patients are unknown. Recent observations suggest that even in patients with a unilateral focus switching from unilateral hippocampal DBS to bilateral hippocampal DBS could improve seizure control.
Compare the effect of unilateral with bilateral hippocampal DBS on seizures in a rat model for TLE.
In the post status epilepticus (SE) kainic acid rat model for TLE continuous EEG monitoring was performed for 50 days during which rats were subjected to 10 days of unilateral and 10 days of bilateral Poisson-distributed high frequency hippocampal DBS in a cross-over trial. During bilateral DBS, each hippocampus was stimulated with a separate stimulator and its own generated Poisson distribution with a mean and variance of 1/130 s.
Electrographic seizure rate was 23% lower during bilateral compared to unilateral hippocampal DBS (P < 0.05). No effect of unilateral nor bilateral hippocampal DBS was observed on seizure duration. When bilateral hippocampal DBS was applied, lower stimulation intensities were required to evoke after discharges (P < 0.05), reflecting a higher potency of bilateral hippocampal DBS compared to unilateral hippocampal DBS to affect hippocampal networks.
Superior outcome in seizure control with bilateral compared to unilateral hippocampal DBS indicates that targeting larger regions of the hippocampal formation with more than one stimulation electrode may be more successful in suppressing seizures in TLE.
在许多颞叶癫痫（TLE）患者中，双侧海马体均为癫痫发作起始区。这些患者不适合进行癫痫手术，但可能适合海马体深部脑刺激（DBS）。这些患者的最佳DBS参数尚不清楚。最近的观察结果表明，即使在单侧病灶的患者中，从单侧海马体DBS转换为双侧海马体DBS也可以改善癫痫控制。
在TLE大鼠模型中比较单侧与双侧海马体DBS对癫痫发作的影响。
在TLE的癫痫持续状态（SE）后海人酸大鼠模型中，进行50天的连续脑电图监测，在此期间，大鼠在交叉试验中接受10天的单侧和10天的双侧泊松分布高频海马体DBS。在双侧DBS期间，每个海马体用单独的刺激器刺激，并具有其自己产生的泊松分布，均值和方差为1/130秒。
与单侧海马体DBS相比，双侧海马体DBS期间的脑电图癫痫发作率降低了23%（P<0.05）。未观察到单侧或双侧海马体DBS对癫痫发作持续时间有影响。当应用双侧海马体DBS时，诱发后放电所需的刺激强度较低（P<0.05），这反映了双侧海马体DBS比单侧海马体DBS对海马体网络的影响更大。
与单侧海马体DBS相比，双侧海马体DBS在癫痫控制方面有更好的效果，这表明用多个刺激电极靶向更大区域的海马结构可能在抑制TLE癫痫发作方面更成功。
