Brain Modulation Lab, Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
University of Pittsburgh Comprehensive Epilepsy Center, Pittsburgh, PA, USA.
Neurotherapeutics. 2019 Jan;16(1):119-127. doi: 10.1007/s13311-018-00682-4.
Closed-loop brain stimulation is one of the few treatments available for patients who are ineligible for traditional surgical resection of the epileptogenic zone, due to having generalized epilepsy, multifocal epilepsy, or focal epilepsy localized to an eloquent brain region. Due to its clinical efficacy and potential to delivery personalized therapy based on an individual's own intracerebral electrophysiology, this treatment is becoming an important part of clinical practice, despite a limited understanding of how to program detection and stimulation parameters for optimal, patient-specific benefit. To bring this challenge into focus, we review the evolution of neural stimulation for epilepsy, provide a technical overview of the RNS System (the only FDA-approved closed-loop device), and discuss the major challenges of working with a closed-loop device. We then propose an evidence-based solution for individualizing therapy that is driven by a bottom-up informatics approach.
闭环脑刺激是少数几种可供选择的治疗方法之一,适用于因患有全身性癫痫、多灶性癫痫或位于功能区的局灶性癫痫而不适合传统的致痫灶切除术的患者。由于其临床疗效以及基于个体自身颅内电生理学提供个性化治疗的潜力,这种治疗方法正在成为临床实践的重要组成部分,尽管人们对如何为最佳的个体化获益编程检测和刺激参数的理解有限。为了关注这一挑战,我们回顾了癫痫的神经刺激的发展,提供了 RNS 系统(唯一获得 FDA 批准的闭环设备)的技术概述,并讨论了使用闭环设备的主要挑战。然后,我们提出了一种基于自下而上信息学方法的个体化治疗的循证解决方案。
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