Departments of1Neurosurgery and.
2Neurology, Mayo Clinic, Rochester, Minnesota.
J Neurosurg. 2018 Aug;129(2):533-543. doi: 10.3171/2017.5.JNS163134. Epub 2017 Oct 20.
OBJECTIVE Epilepsy surgery is effective for lesional epilepsy, but it can be associated with significant morbidity when seizures originate from eloquent cortex that is resected. Here, the objective was to describe chronic subthreshold cortical stimulation and evaluate its early surgical safety profile in adult patients with epilepsy originating from seizure foci in cortex that is not amenable to resection. METHODS Adult patients with focal drug-resistant epilepsy underwent intracranial electroencephalography monitoring for evaluation of resection. Those with seizure foci in eloquent cortex were not candidates for resection and were offered a short therapeutic trial of continuous subthreshold cortical stimulation via intracranial monitoring electrodes. After a successful trial, electrodes were explanted and permanent stimulation hardware was implanted. RESULTS Ten patients (6 males) who underwent chronic subthreshold cortical stimulation between 2014 and 2016 were included. Based on radiographic imaging, intracranial pathologies included cortical dysplasia (n = 3), encephalomalacia (n = 3), cortical tubers (n = 1), Rasmussen encephalitis (n = 1), and linear migrational anomaly (n = 1). The duration of intracranial monitoring ranged from 3 to 20 days. All patients experienced an uneventful postoperative course and were discharged home with a median length of stay of 10 days. No postoperative surgical complications developed (median follow-up length 7.7 months). Seizure severity and seizure frequency improved in all patients. CONCLUSIONS The authors' institutional experience with this small group shows that chronic subthreshold cortical stimulation can be safely and effectively performed in appropriately selected patients without postoperative complications. Future investigation will provide further insight to recently published results regarding mechanism and efficacy of this novel and promising intervention.
癫痫手术对病变性癫痫有效，但如果癫痫起源于需要切除的优势脑区，则可能会出现严重的发病率。本研究旨在描述慢性亚阈皮质刺激，并评估其在起源于无法切除的皮质病灶的成年癫痫患者中的早期手术安全性。
接受颅内脑电图监测以评估切除的局灶性药物难治性癫痫成年患者，如果癫痫灶位于优势脑区，不适合切除，则可选择进行颅内监测电极的连续亚阈皮质刺激短期治疗试验。如果试验成功，将取出电极并植入永久性刺激硬件。
2014 年至 2016 年间，10 名（6 名男性）接受慢性亚阈皮质刺激的患者纳入本研究。根据影像学检查，颅内病变包括皮质发育不良（n = 3）、脑软化（n = 3）、皮质结节（n = 1）、Rasmussen 脑炎（n = 1）和线状移行异常（n = 1）。颅内监测时间从 3 天到 20 天不等。所有患者术后均无并发症，并在中位数为 10 天的住院时间后出院回家。无术后手术并发症发生（中位数随访时间 7.7 个月）。所有患者的癫痫严重程度和发作频率均有所改善。
作者所在机构的小样本经验表明，慢性亚阈皮质刺激在适当选择的患者中可以安全有效地进行，且无术后并发症。未来的研究将为该新的、有前景的干预措施的机制和疗效提供进一步的见解。
