Lee Ching-Yi, Lim Siew-Na, Wu Tony, Lee Shih-Tseng
Department of Neurosurgery, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kweishan, Taoyuan, Taiwan.
Department of Neurology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kweishan, Taoyuan, Taiwan.
World Neurosurg. 2017 Mar;99:14-18. doi: 10.1016/j.wneu.2016.11.097. Epub 2016 Nov 25.
Refractory status epilepticus (RSE) is considered a medical emergency in neurology and is related to high mortality. We report a successfully treated case of RSE using deep brain stimulation (DBS) at the anterior thalamic nuclei (ATN) in a 17-year-old woman.
This patient developed RSE as a result of progressive seizure activity. RSE with generalized tonic-clonic seizures was noted 2 weeks before admission. Video electroencephalography monitoring showed continuous 3-Hz generalized spike-and-wave complexes with higher amplitude over bilateral frontal. Four weeks after RSE onset, bilateral DBS of the ATN was started. This treatment was immediately followed by the disappearance of tonic-clonic seizures and spike-and-wave complexes, suggesting resolution of the RSE. Significant clinical improvement was noted 1 week after DBS implantation.
DBS at the ATN significantly improved both the electroencephalography and clinical presentation in the patient with RSE. DBS at the ATN should be considered as a possible treatment choice once a patient develops RSE.
难治性癫痫持续状态（RSE）在神经病学中被视为医疗急症，且与高死亡率相关。我们报告了一例17岁女性患者，通过丘脑前核（ATN）深部脑刺激（DBS）成功治疗RSE的病例。
该患者因进行性癫痫发作活动而发展为RSE。入院前2周出现伴有全身强直阵挛发作的RSE。视频脑电图监测显示双侧额叶出现持续的3赫兹全身性棘慢复合波，且振幅更高。RSE发作4周后，开始双侧ATN的DBS治疗。该治疗后立即出现强直阵挛发作和棘慢复合波消失，提示RSE得到缓解。DBS植入1周后，临床有显著改善。
ATN的DBS显著改善了RSE患者的脑电图和临床表现。一旦患者发生RSE，应考虑将ATN的DBS作为一种可能的治疗选择。
