Department of Neurology, Catholic Neuroscience Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Department of Neurology, Korea University Ansan Hospital, College of Medicine, Korea University, Ansan, Republic of Korea.
Seizure. 2017 Nov;52:154-161. doi: 10.1016/j.seizure.2017.10.009. Epub 2017 Oct 14.
Anterior thalamic deep brain stimulation (ATN DBS) is an emerging, effective treatment for patients with drug-resistant epilepsy, but long-term results on its efficacy and safety are lacking. To evaluate the long-term efficacy and safety of ATN DBS treatment, as well as predictors of its success, in patients with drug-refractory epilepsy (DRE).
We retrospectively studied clinical outcomes in 29 consecutive refractory epilepsy patients treated by a single DBS team (two neurosurgeons, four neurologists) over an 11-year period, for whom follow-up was performed for up to 137 months (mean, 74.9 months).
The average participant was 30.7 (±10.4) years old and had epilepsy for 19.3 (±9.0) years. The mean preoperative frequency of disabling partial or generalized tonic-clonic seizures was 27.5 (±8.6, SE) seizures a month. The median percent seizure reduction was 71.3% at 1year, 73.9% at 2 years, and ranged from 61.8% to 80.0% over post-implant years 3 through 11 in the long-term study (overall 70% median reduction). In the 11-year study period, 13.8% (4/29) of subjects were seizure-free for at least 12 months during this time. There was only one symptomatic intracranial hemorrhage that happened during follow-up (3.4%). Infection requiring removal and later re-implantation of hardware occurred in only 1 of 30 patients (3.3%), who was subsequently excluded from our follow-up assessment. Hardware malfunction including lead disconnection occurred in 2 of 29 cases (6.9%). Revision of lead position to redeem poor clinical response was performed in 3 of 58 implanted leads (5.2%).
ATN DBS can be an effective therapy in a variety of patients with DRE. Importantly, we provide evidence that significant therapeutic efficacy can be sustained for up to 11 years. Neurological complications were rather rare, but long-term hardware-related complications should be followed arrectis auribus.
前丘脑深部脑刺激（ATN DBS）是一种新兴的、有效的治疗药物难治性癫痫的方法，但缺乏其长期疗效和安全性的数据。本研究旨在评估 ATN DBS 治疗药物难治性癫痫（DRE）患者的长期疗效和安全性，以及预测其成功的因素。
我们对一个单中心的 DBS 治疗团队（2 名神经外科医生和 4 名神经科医生）在 11 年期间治疗的 29 例难治性癫痫患者进行了回顾性研究，最长随访时间为 137 个月（平均 74.9 个月）。
平均年龄为 30.7（±10.4）岁，癫痫病史为 19.3（±9.0）年。术前每月有残疾性部分或全面强直阵挛发作的平均频率为 27.5（±8.6，SE）次。1 年时的中位癫痫发作减少率为 71.3%，2 年时为 73.9%，植入后 3 至 11 年的长期研究中，癫痫发作减少率范围为 61.8%至 80.0%（总体中位数减少 70%）。在 11 年的研究期间，13.8%（4/29）的患者在这段时间内至少有 12 个月无癫痫发作。在随访期间只有 1 例（3.4%）发生症状性颅内出血。只有 1 例（3.3%）患者因感染需要移除和重新植入硬件，该患者随后被排除在我们的随访评估之外。只有 2 例（6.9%）发生硬件故障，包括导联断开。对 58 个植入导联中的 3 个（5.2%）进行了导联位置修正，以改善临床疗效不佳的情况。
ATN DBS 可以成为治疗 DRE 的有效方法。重要的是，我们提供的证据表明，其显著的治疗效果可以持续长达 11 年。神经系统并发症较为罕见，但长期硬件相关并发症应引起关注。
