Gummadavelli Abhijeet, Zaveri Hitten P, Spencer Dennis D, Gerrard Jason L
Department of Neurosurgery, Yale University School of Medicine, Yale University, New Haven, CT, United States.
Department of Neurology, Yale University School of Medicine, Yale University, New Haven, CT, United States.
Front Neurosci. 2018 Jul 31;12:474. doi: 10.3389/fnins.2018.00474. eCollection 2018.
Seizures have traditionally been considered hypersynchronous excitatory events and epilepsy has been separated into focal and generalized epilepsy based largely on the spatial distribution of brain regions involved at seizure onset. Epilepsy, however, is increasingly recognized as a complex network disorder that may be distributed and dynamic. Responsive neurostimulation (RNS) is a recent technology that utilizes intracranial electroencephalography (EEG) to detect seizures and delivers stimulation to cortical and subcortical brain structures for seizure control. RNS has particular significance in the clinical treatment of medically refractory epilepsy and brain-computer interfaces in epilepsy. Closed loop RNS represents an important step forward to understand and target nodes in the seizure network. The thalamus is a central network node within several functional networks and regulates input to the cortex; clinically, several thalamic nuclei are safe and feasible targets. We highlight the network theory of epilepsy, potential targets for neuromodulation in epilepsy and the first reported use of RNS as a first generation brain-computer interface to detect and stimulate the centromedian intralaminar thalamic nucleus in a patient with bilateral cortical onset of seizures. We propose that advances in network analysis and neuromodulatory techniques using brain-computer interfaces will significantly improve outcomes in patients with epilepsy. There are numerous avenues of future direction in brain-computer interface devices including multi-modal sensors, flexible electrode arrays, multi-site targeting, and wireless communication.
传统上，癫痫发作被认为是超同步兴奋性事件，癫痫主要根据发作起始时受累脑区的空间分布分为局灶性癫痫和全身性癫痫。然而，癫痫越来越被认为是一种复杂的网络障碍，可能是分布式和动态的。响应性神经刺激（RNS）是一种利用颅内脑电图（EEG）检测癫痫发作并向皮质和皮质下脑结构传递刺激以控制癫痫发作的最新技术。RNS在药物难治性癫痫的临床治疗和癫痫的脑机接口方面具有特殊意义。闭环RNS代表了在理解癫痫发作网络中的节点并将其作为靶点方面向前迈出的重要一步。丘脑是几个功能网络中的一个核心网络节点，调节对皮质的输入；临床上，几个丘脑核是安全可行的靶点。我们强调癫痫的网络理论、癫痫中神经调节的潜在靶点，以及首次报道将RNS作为第一代脑机接口用于检测和刺激双侧皮质起始癫痫发作患者的中央中隔层丘脑核。我们认为，使用脑机接口的网络分析和神经调节技术的进步将显著改善癫痫患者的治疗效果。脑机接口设备未来有许多发展方向，包括多模态传感器、柔性电极阵列、多部位靶向和无线通信。
