Boongird Atthaporn, Boongird Apisit, Khongkhatithum Chaiyos, Thampratankul Lunliya, Visudtibhan Anannit
J Med Assoc Thai. 2016 Jun;99 Suppl 3:S126-9.
Neurostimulation can be an alternative treatment for medically intractable epilepsy, especially when the resective surgery could not be performed. The author reported a case of 19-year-old, right-handed male patient who had a history of intractable epilepsy for 11 years after post viral encephalitis associated with status epilepticus. Following the failure of antiepileptic medications and then resective surgery, anterior thalamic deep brain stimulation (DBS) was performed. Indirect targeting of anterior thalamic nuclei could not be used because of asymmetric brain shift from prior multilobar resections. Direct targeting of anterior thalamic nuclei from MRI T1 sequence, Short Tau Inversion Recovery (STIR) sequence combined neurophysiological mapping by microelectrode recording were used as a technique for implantation of DBS electrodes. The stimulation was turned on with 145 Hz, pulse width 90 microseconds, 5 volts with cycling mode 1 minute “on” and 5 minutes “0ff”. The antiepileptic medications continued the same as pre-operative state. Sixty percent seizure reduction was achieved in 24 months after surgery. There were no side effects of DBS during the follow-up period. Anterior thalamic DBS can be performed safely with satisfactory seizure outcomes. Direct targeting of anterior thalamic nuclei combination with microelectrode recording can be very helpful, especially when asymmetric basal ganglion structures were detected.
神经刺激可以作为药物难治性癫痫的一种替代治疗方法，尤其是在无法进行切除性手术的情况下。作者报告了一例19岁的右利手男性患者，该患者在病毒性脑炎合并癫痫持续状态后有11年的难治性癫痫病史。在抗癫痫药物治疗失败并随后进行切除性手术后，进行了丘脑前深部脑刺激（DBS）。由于先前多叶切除导致的不对称脑移位，无法使用间接靶向丘脑前核。通过MRI T1序列、短tau反转恢复（STIR）序列直接靶向丘脑前核，并结合微电极记录进行神经生理学图谱，作为植入DBS电极的技术。以145Hz、脉冲宽度90微秒、5伏的参数开启刺激，循环模式为1分钟“开”和5分钟“关”。抗癫痫药物继续维持术前状态。术后24个月癫痫发作减少了60%。随访期间DBS没有副作用。丘脑前DBS可以安全进行，癫痫发作结果令人满意。直接靶向丘脑前核并结合微电极记录可能非常有帮助，尤其是在检测到不对称基底神经节结构时。
