Tröster Alexander I, Meador Kimford J, Irwin Christopher P, Fisher Robert S
Department of Clinical Neuropsychology and Center for Neuromodulation, Barrow Neurological Institute, Phoenix, AZ, USA.
Department of Neurology & Neurological Sciences, Stanford University, Stanford, CA, USA.
Seizure. 2017 Feb;45:133-141. doi: 10.1016/j.seizure.2016.12.014. Epub 2016 Dec 23.
Bilateral deep brain stimulation (DBS) of the anterior nucleus of the thalamus (ANT) reduces seizures and is relatively safe but may be accompanied by complaints of memory problems and depression. This study examined incidence of memory and depression adverse events (AE) in the SANTE study blinded phase and their relationship to objective neurobehavioral measures, baseline characteristics, quality of life and long-term neurobehavioral outcome.
The neurobehavioral AE and neuropsychological data from a previously reported prospective randomized trial (SANTE) were analyzed. Reliable change indices (RCI) were calculated for memory and mood measures. Analyses examined relationships among AEs, RCIs, demographic and seizure variables, and long-term neurobehavioral outcome.
No significant cognitive declines or worsening of depression scores were observed through the blinded phase or in open-label at 7-years. Higher scores were observed at 7 years on measures of executive functions and attention. Depression and memory-related AEs were not associated with reliable change on objective measures or 7-year neurobehavioral outcome. The AEs were without significant impact on life quality. Memory and depression AEs were not related to demographic or seizure characteristics, change in seizure frequency, frequency of AE or depression report.
Bilateral ANT DBS was associated with subjective depression and memory AEs during the blinded phase in a minority of patients that were not accompanied by objective, long-term neurobehavioral worsening. Monitoring and neuropsychological assessment of depression and memory are recommended from a theoretical standpoint and because more memory and depression AEs occurred in the active stimulation than control group.
双侧丘脑前核（ANT）深部脑刺激（DBS）可减少癫痫发作且相对安全，但可能伴有记忆问题和抑郁的主诉。本研究调查了SANTE研究盲法阶段记忆和抑郁不良事件（AE）的发生率及其与客观神经行为指标、基线特征、生活质量和长期神经行为结果的关系。
分析了先前报道的一项前瞻性随机试验（SANTE）的神经行为AE和神经心理学数据。计算了记忆和情绪指标的可靠变化指数（RCI）。分析考察了AE、RCI、人口统计学和癫痫变量以及长期神经行为结果之间的关系。
在盲法阶段或7年的开放标签阶段，未观察到显著的认知下降或抑郁评分恶化。在7年时，执行功能和注意力指标的得分较高。抑郁和记忆相关AE与客观指标的可靠变化或7年神经行为结果无关。这些AE对生活质量没有显著影响。记忆和抑郁AE与人口统计学或癫痫特征、癫痫发作频率变化、AE频率或抑郁报告频率无关。
双侧ANT DBS在少数患者的盲法阶段与主观抑郁和记忆AE相关，但未伴有客观的、长期的神经行为恶化。从理论角度以及因为在积极刺激组比对照组出现了更多的记忆和抑郁AE，建议对抑郁和记忆进行监测和神经心理学评估。
