Lin Yicong, Wang Yuping
Department of Neurology Xuanwu Hospital Capital Medical University Beijing China.
Beijing Key Laboratory of Neuromodulation Beijing China.
Epilepsia Open. 2017 Aug 23;2(4):371-387. doi: 10.1002/epi4.12070. eCollection 2017 Dec.
The revolution in theory, swift technological developments, and invention of new devices have driven tremendous progress in neurostimulation as a third-line treatment for epilepsy. Over the past decades, neurostimulation took its place in the field of epilepsy as an advanced treatment technique and opened up a new world. Numerous animal studies have proven the physical efficacy of stimulation of the brain and peripheral nerves. Based on this optimistic fundamental research, new advanced techniques are being explored in clinical practice. Over the past century, drawing on the benefits brought about by vagus nerve stimulation for the treatment of epilepsy, various new neurostimulation modalities have been developed to control seizures. Clinical studies including case reports, case series, and clinical trials have been booming in the past several years. This article gives a comprehensive review of most of these clinical studies. In addition to highlighting the advantages of neurostimulation for the treatment of epilepsy, concerns with this modality and future development directions are also discussed. The biggest advantage of neurostimulation over pharmacological treatments for epilepsy is the modulation of the epilepsy network by delivering stimuli at a specific target or the "hub." Conversely, however, a lack of knowledge of epilepsy networks and the mechanisms of neurostimulation may hinder further development. Therefore, theoretical research on the mechanism of epileptogenesis and epilepsy networks is needed in the future. Within the multiple modalities of neuromodulation, the final choice should be made after full discussion with a multidisciplinary team at a presurgical conference. Furthermore, the establishment of a neurostimulation system with standardized parameters and rigorous guidelines is another important issue. To achieve this goal, a worldwide collaboration of epilepsy centers is also suggested in the future.
理论上的革命、迅速的技术发展以及新设备的发明推动了神经刺激作为癫痫三线治疗方法取得了巨大进展。在过去几十年里，神经刺激作为一种先进的治疗技术在癫痫领域占据了一席之地，并开辟了一个全新的世界。大量动物研究已经证实了刺激大脑和外周神经的物理效果。基于这一乐观的基础研究，临床实践中正在探索新的先进技术。在过去的一个世纪里，借鉴迷走神经刺激治疗癫痫所带来的益处，人们开发了各种新的神经刺激方式来控制癫痫发作。在过去几年中，包括病例报告、病例系列和临床试验在内的临床研究蓬勃发展。本文对其中的大多数临床研究进行了全面综述。除了强调神经刺激治疗癫痫的优势外，还讨论了对这种治疗方式的担忧以及未来的发展方向。神经刺激相对于癫痫药物治疗的最大优势在于通过在特定靶点或“枢纽”传递刺激来调节癫痫网络。然而，相反的是，对癫痫网络和神经刺激机制缺乏了解可能会阻碍进一步发展。因此，未来需要对癫痫发生机制和癫痫网络进行理论研究。在多种神经调节方式中，最终的选择应在术前会议上与多学科团队充分讨论后做出。此外，建立具有标准化参数和严格指南的神经刺激系统是另一个重要问题。为实现这一目标，未来还建议癫痫中心进行全球合作。
