Sitnikov A R, Grigoryan Yu A, Mishnyakova L P
Federal Center of Treatment and Rehabilitation, Moscow, Russia.
Zh Vopr Neirokhir Im N N Burdenko. 2016;80(3):25-34. doi: 10.17116/neiro201680325-34.
Identification of the crucial role of the anterior thalamic nuclei (ATN) in the generalization of seizures led to increased interest in surgical interventions in this particular area in intractable epilepsy patients. Simulation of ATN destruction in animals demonstrated its high efficacy for both preventing the seizure development and reducing the seizure rate. However, bilateral radiofrequency destruction of the anterior thalamic nuclei in humans has not yet bee described.
The study objective was to perform bilateral radiofrequency anterior thalamotomy in intractable epilepsy patients and to evaluate its
We performed for the first time bilateral stereotactic radiofrequency thermocoagulation of ATN in 13 patients with long-term intractable epilepsy. Before surgery, we assessed the disease duration, age of seizure onset, localization of pathological activity sources, and types of seizures, morphological damages, and ongoing pharmacotherapy. All interventions were performed under local anesthesia and were accompanied by intraoperative microelectrode monitoring of the neuronal activity and by EEG.
Seven males and 6 females, aged 22 to 48 years, were operated on. All patients had epileptogenic foci in the frontal and/or temporal lobes. MRI revealed epileptogenic structural abnormalities in 3 patients. There were no postoperative complications. According to a postoperative examination, 5 patients were seizure-free; a decrease in the seizure rate was 70% in 6 patients and 50% in 1 patient; 1 patient had no response to the surgery. The resulting effect was manifested not only in a reduction in the frequency and severity of seizures but also in a decrease in the dose of administered anticonvulsants. EEG also showed a significant improvement in the majority of patients.
Our experience demonstrates that bilateral radiofrequency anterior thalamotomy is a safe and effective technique to control seizures in humans. Further research will clarify, based on the clinical and EEG data, the patient selection criteria for surgical treatment.
前丘脑核（ATN）在癫痫泛化中的关键作用被发现后，难治性癫痫患者对该特定区域手术干预的兴趣增加。动物实验中模拟前丘脑核破坏显示其在预防癫痫发作发展和降低癫痫发作率方面具有高效性。然而，人类双侧前丘脑核的射频毁损术尚未见报道。
本研究旨在对难治性癫痫患者实施双侧射频前丘脑切开术并评估其效果。
我们首次对13例长期难治性癫痫患者实施了双侧立体定向射频热凝前丘脑核手术。术前，我们评估了病程、癫痫发作起始年龄、病理活动源定位、癫痫发作类型、形态学损伤及正在进行的药物治疗情况。所有手术均在局部麻醉下进行，术中伴有神经元活动的微电极监测及脑电图监测。
接受手术的患者共13例，其中男性7例，女性6例，年龄在22至48岁之间。所有患者的致痫灶均位于额叶和/或颞叶。MRI显示3例患者有致痫性结构异常。术后无并发症发生。术后检查显示，5例患者无癫痫发作；6例患者癫痫发作率降低70%，1例患者降低50%；1例患者手术无效。手术效果不仅表现为癫痫发作频率和严重程度降低，还表现为抗惊厥药物剂量减少。脑电图显示大多数患者也有显著改善。
我们的经验表明，双侧射频前丘脑切开术是一种安全有效的控制人类癫痫发作的技术。基于临床和脑电图数据的进一步研究将明确手术治疗的患者选择标准。
