Saipetch Chutima, Sachs Ezekiel, Haneef Zulfi
Baylor College of Medicine (CS), Houston, TX; Emory University (ES), Atlanta, GA; and Baylor College of Medicine and the VA Medical Center (ZH), Houston, TX.
Neurol Clin Pract. 2016 Oct;6(5):444-451. doi: 10.1212/CPJ.0000000000000288.
Technological advance has revolutionized epilepsy management recently. Herein, we review some recent developments.
Responsive neurostimulation (Food and Drug Administration [FDA]-approved 2013) works by continuous analysis of brain rhythms and direct brain stimulation on detecting patterns thought to be epileptogenic, thereby aborting seizures. Cardio-responsive vagus nerve stimulation (FDA-approved 2015) is an improvement over traditional vagus nerve stimulation systems, taking advantage of the fact that 80% of seizures are associated with tachycardia. Automated tachycardia detection leads to vagus nerve stimulation to abort seizures. In MRI-guided stereotactic laser ablation (developed 2012), a directed laser emitting fiberoptic catheter is used to ablate epileptogenic lesions. The procedure can be completed in 3 to 4 hours, potentially under local anesthesia and with next-day discharge. Perampanel (FDA-approved 2012) is a promising new class of AMPA (α-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid)-antagonist antiseizure therapy. Meanwhile, a millennia-old remedy for epilepsy, cannabis, is staging a comeback with recent legal and social permissiveness accelerating research into this use.
The coming years will demonstrate how these recent advances in device and drug management will improve the care of epilepsy.
技术进步最近彻底改变了癫痫的管理方式。在此，我们回顾一些近期的进展。
响应性神经刺激（2013年获得美国食品药品监督管理局[FDA]批准）通过持续分析脑电波，并在检测到被认为是致痫性的模式时直接刺激大脑，从而终止癫痫发作。心脏响应性迷走神经刺激（2015年获得FDA批准）是对传统迷走神经刺激系统的改进，利用了80%的癫痫发作与心动过速有关这一事实。自动检测心动过速会引发迷走神经刺激以终止癫痫发作。在MRI引导的立体定向激光消融术（2012年研发）中，使用定向发射激光的光纤导管来消融致痫性病变。该手术可在3至4小时内完成，可能在局部麻醉下进行，且患者次日即可出院。吡仑帕奈（2012年获得FDA批准）是一种有前景的新型α-氨基-3-羟基-5-甲基-4-异恶唑丙酸（AMPA）拮抗剂抗癫痫疗法。与此同时，一种有着数千年历史的癫痫治疗药物大麻，随着近期法律和社会层面的许可加快了对此用途的研究，正在卷土重来。
未来几年将展示这些在设备和药物管理方面的最新进展如何改善癫痫的治疗。
