丘脑反应性神经刺激改善特发性全面性癫痫的癫痫控制：病例报告。
Responsive Neurostimulation of the Thalamus Improves Seizure Control in Idiopathic Generalized Epilepsy: A Case Report.
机构信息
Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts.
Harvard Medical School, Boston, Massachusetts.
出版信息
Neurosurgery. 2020 Oct 15;87(5):E578-E583. doi: 10.1093/neuros/nyaa001.
BACKGROUND AND IMPORTANCE
At least 25% of patients with idiopathic generalized epilepsy do not obtain adequate seizure control with medication. This report describes the first use of responsive neurostimulation (RNS), bilaterally targeting the centromedian/ventrolateral (CM/VL) region in a patient with drug-refractory Jeavons syndrome (eyelid myoclonia with absences).
CLINICAL PRESENTATION
A patient, diagnosed with eyelid myoclonia with absences (EMA) and refractory to medication, was offered RNS treatment in the CM/VL region of the thalamus. Stimulation was triggered by thalamic neural activity having morphological, spectral, and synchronous features that corresponded to 3- to 5-Hz spike-wave discharges recorded on prior scalp electroencephalography.
CONCLUSION
RNS decreased daily absence seizures from a mean of 60 to ≤10 and maintained the patient's level of consciousness during the occurring episodes. This therapy should be evaluated further for its potential to treat patients with pharmaco-refractory generalized epilepsy.
背景与重要性
至少 25%的特发性全面性癫痫患者药物治疗无法获得充分的癫痫发作控制。本报告描述了首例使用反应性神经刺激（RNS）双侧靶向丘脑中央中核/腹外侧核（CM/VL）区域治疗药物难治性 Jeavons 综合征（眼睑肌阵挛伴失神）患者。
临床表现
一位被诊断为眼睑肌阵挛伴失神（EMA）且药物难治的患者，在丘脑的 CM/VL 区域接受 RNS 治疗。刺激由具有形态、频谱和同步特征的丘脑神经活动触发，这些特征与之前头皮脑电图记录的 3-5Hz 棘慢波放电相对应。
结论
RNS 使每日失神发作次数从平均 60 次减少至≤10 次，且在发作期间保持患者的意识水平。这种治疗方法应进一步评估其治疗药物难治性全面性癫痫患者的潜力。
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