Chen Hai, Dugan Patricia, Chong Derek J, Liu Anli, Doyle Werner, Friedman Daniel
Comprehensive Epilepsy Center Department of Neurology NYU Langone Medical Center New York New York U.S.A.
Department of Neurology School of Medicine and Health Sciences George Washington University Washington District of Columbia U.S.A.
Epilepsia Open. 2017 Jul 4;2(3):345-349. doi: 10.1002/epi4.12061. eCollection 2017 Sep.
Although responsive neurostimulation (RNS) is approved for treatment of resistant focal epilepsy in adults, little is known about response to treatment of specific cortical targets. We describe the experience of RNS targeting the insular lobe. We identified patients who had RNS implantation with at least one electrode within the insula between April 2014 and October 2015. We performed a retrospective review of preoperative clinical features, imaging, electrocardiogram (EEG), intraoperative electrocorticography (ECoG), and postoperative seizure outcome. Eight patients with at least 6 months of postimplant follow-up were identified. Ictal localization was inconclusive with MRI or scalp EEG findings. Intracranial EEG monitoring or intraoperative ECoG demonstrated clear ictal onsets and/or frequent interictal discharges in the insula. Four patients demonstrated overall 50-75% reduction in seizure frequency. Two patients did not show appreciable seizure improvement. One patient has experienced a 75% reduction of seizure frequency, and another is nearly seizure free postoperatively. There were no reported direct complications of insular RNS electrode placement or stimulation, though two patients had postoperative complications thought to be related to craniotomy (hydrocephalus and late infection). Our study suggests that insular RNS electrode placement in selected patients is relatively safe and that RNS treatment may benefit selected patients with insular epilepsy.
尽管反应性神经刺激（RNS）已被批准用于治疗成人耐药性局灶性癫痫，但对于特定皮质靶点的治疗反应却知之甚少。我们描述了以岛叶为靶点的RNS治疗经验。我们确定了在2014年4月至2015年10月期间接受RNS植入且至少有一个电极位于岛叶内的患者。我们对术前临床特征、影像学、心电图（EEG）、术中皮质脑电图（ECoG）以及术后癫痫发作结果进行了回顾性分析。确定了8例植入后至少随访6个月的患者。发作期定位与MRI或头皮EEG结果不一致。颅内EEG监测或术中ECoG显示岛叶有明确的发作起始和/或频繁的发作间期放电。4例患者的癫痫发作频率总体降低了50%-75%。2例患者的癫痫发作没有明显改善。1例患者的癫痫发作频率降低了75%，另1例患者术后几乎无癫痫发作。尽管有2例患者出现了被认为与开颅手术相关的术后并发症（脑积水和晚期感染），但未报告岛叶RNS电极置入或刺激的直接并发症。我们的研究表明，在选定患者中进行岛叶RNS电极置入相对安全，且RNS治疗可能使选定的岛叶癫痫患者受益。
