Voges Berthold R, Schmitt Friedhelm C, Hamel Wolfgang, House Patrick M, Kluge Christian, Moll Christian K E, Stodieck Stefan R
Department of Epileptology, Protestant Hospital Alsterdorf, Hamburg, Germany.
Department of Neurology, University of Magdeburg, Magdeburg, Germany.
Epilepsia. 2015 Aug;56(8):e99-e103. doi: 10.1111/epi.13045. Epub 2015 Jun 4.
In view of the regulatory function of the thalamus in the sleep-wake cycle, the impact of deep brain stimulation (DBS) of the anterior nucleus thalami (ANT) on sleep was assessed in a small consecutive cohort of epilepsy patients with standardized polysomnography (PSG). In nine patients treated with ANT-DBS (voltage 5 V, frequency 145 Hz, cyclic mode), the number of arousals during stimulation and nonstimulation periods, neuropsychiatric symptoms (npS), and seizure frequency were determined. Electroclinical arousals were triggered in 14.0 to 67.0% (mean 42.4 ± SD 16.8%) of all deep brain stimuli. Six patients reported npS. Nocturnal DBS voltages were reduced in eight patients (one patient without npS refused) and PSGs were repeated. Electroclinical arousals occurred between 1.4 and 6.7 (mean 3.3 ± 1.7) times more frequently during stimulation periods compared to nonstimulation periods; the number of arousals positively correlated with the level of DBS voltage (range 1 V to 5 V) (Spearman's rank coefficient 0.53121; p < 0.05). No patient experienced seizure deterioration and four patients reported remission of npS. This case-cohort study provides evidence that ANT-DBS interrupts sleep in a voltage-dependent manner, thus putatively resulting in an increase of npS. Reduction of nocturnal DBS voltage seems to lead to improvement of npS without hampering efficacy of ANT-DBS.
鉴于丘脑在睡眠-觉醒周期中的调节功能，在一小群连续的癫痫患者中，采用标准化多导睡眠图（PSG）评估了丘脑前核（ANT）的深部脑刺激（DBS）对睡眠的影响。在9例接受ANT-DBS治疗的患者（电压5V，频率145Hz，循环模式）中，测定了刺激期和非刺激期的觉醒次数、神经精神症状（npS）和癫痫发作频率。在所有深部脑刺激中，14.0%至67.0%（平均42.4±标准差16.8%）触发了电临床觉醒。6例患者报告有npS。8例患者（1例无npS的患者拒绝）降低了夜间DBS电压，并重复进行了PSG检查。与非刺激期相比，刺激期电临床觉醒的发生频率高1.4至6.7倍（平均3.3±1.7）；觉醒次数与DBS电压水平（范围1V至5V）呈正相关（Spearman等级系数0.53121；p<0.05）。没有患者出现癫痫恶化，4例患者报告npS缓解。这项病例队列研究提供了证据，表明ANT-DBS以电压依赖的方式中断睡眠，从而可能导致npS增加。降低夜间DBS电压似乎可改善npS，而不影响ANT-DBS的疗效。
