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闭环脑刺激治疗耐药性癫痫:迈向基于证据的个体化医学方法。

Closed-Loop Brain Stimulation for Drug-Resistant Epilepsy: Towards an Evidence-Based Approach to Personalized Medicine.

机构信息

Brain Modulation Lab, Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA.

University of Pittsburgh Comprehensive Epilepsy Center, Pittsburgh, PA, USA.

出版信息

Neurotherapeutics. 2019 Jan;16(1):119-127. doi: 10.1007/s13311-018-00682-4.


DOI:10.1007/s13311-018-00682-4
PMID:30378004
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6361057/
Abstract

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.

摘要

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。

相似文献

[1]
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[2]
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[3]
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[4]
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[5]
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[6]
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[7]
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[8]
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[9]
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[10]
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[2]
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J Epilepsy Res. 2025-6-10

[3]
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Biosensors (Basel). 2025-6-6

[4]
Vibrotactile auricular vagus nerve stimulation alters limbic system connectivity in humans: A pilot study.

PLoS One. 2025-5-29

[5]
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[6]
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[7]
Advancements in Surgical Therapies for Drug-Resistant Epilepsy: A Paradigm Shift towards Precision Care.

Neurol Ther. 2025-4

[8]
A Comprehensive Review of Recent Trends in Surgical Approaches for Epilepsy Management.

Cureus. 2024-10-17

[9]
Closing the Loop for Precise Seizure Control.

Epilepsy Curr. 2024-3-1

[10]
The bidirectional relationship between the cerebellum and seizure networks: a double-edged sword.

Curr Opin Behav Sci. 2023-12

本文引用的文献

[1]
Technique of Whole-Sellar Stereotactic Radiosurgery for Cushing Disease: Results from a Multicenter, International Cohort Study.

World Neurosurg. 2018-8

[2]
Multi-day rhythms modulate seizure risk in epilepsy.

Nat Commun. 2018-1-8

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Treatment Outcomes in Patients With Newly Diagnosed Epilepsy Treated With Established and New Antiepileptic Drugs: A 30-Year Longitudinal Cohort Study.

JAMA Neurol. 2018-3-1

[4]
Effects of hippocampal low-frequency stimulation in idiopathic non-human primate epilepsy assessed via a remote-sensing-enabled neurostimulator.

Exp Neurol. 2017-5-7

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Brain-responsive neurostimulation in patients with medically intractable mesial temporal lobe epilepsy.

Epilepsia. 2017-4-11

[6]
Brain-responsive neurostimulation in patients with medically intractable seizures arising from eloquent and other neocortical areas.

Epilepsia. 2017-4-7

[7]
Neurostimulation Devices Used in Treatment of Epilepsy.

Curr Treat Options Neurol. 2017-2

[8]
Which outcomes should we measure in adult epilepsy trials? The views of people with epilepsy and informal carers.

Epilepsy Behav. 2016-6

[9]
Crowdsourcing reproducible seizure forecasting in human and canine epilepsy.

Brain. 2016-6

[10]
Vagus nerve stimulation therapy: indications, programing, and outcomes.

Neurol Med Chir (Tokyo). 2015

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