经长期颅内脑电监测和直接脑反应性神经刺激系统引导行颞叶内侧切除术。

Mesial temporal resection following long-term ambulatory intracranial EEG monitoring with a direct brain-responsive neurostimulation system.

机构信息

Yale University School of Medicine, New Haven, CT, USA.

NeuroPace, Inc., Mountain View, CA, USA.

出版信息

Epilepsia. 2020 Mar;61(3):408-420. doi: 10.1111/epi.16442. Epub 2020 Feb 18.

DOI:10.1111/epi.16442

PMID:32072621

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7154711/

Abstract

OBJECTIVE

To describe seizure outcomes in patients with medically refractory epilepsy who had evidence of bilateral mesial temporal lobe (MTL) seizure onsets and underwent MTL resection based on chronic ambulatory intracranial EEG (ICEEG) data from a direct brain-responsive neurostimulator (RNS) system.

METHODS

We retrospectively identified all patients at 17 epilepsy centers with MTL epilepsy who were treated with the RNS System using bilateral MTL leads, and in whom an MTL resection was subsequently performed. Presumed lateralization based on routine presurgical approaches was compared to lateralization determined by RNS System chronic ambulatory ICEEG recordings. The primary outcome was frequency of disabling seizures at last 3-month follow-up after MTL resection compared to seizure frequency 3 months before MTL resection.

RESULTS

We identified 157 patients treated with the RNS System with bilateral MTL leads due to presumed bitemporal epilepsy. Twenty-five patients (16%) subsequently had an MTL resection informed by chronic ambulatory ICEEG (mean = 42 months ICEEG); follow-up was available for 24 patients. After MTL resection, the median reduction in disabling seizures at last follow-up was 100% (mean: 94%; range: 50%-100%). Nine patients (38%) had exclusively unilateral electrographic seizures recorded by chronic ambulatory ICEEG and all were seizure-free at last follow-up after MTL resection; eight of nine continued RNS System treatment. Fifteen patients (62%) had bilateral MTL electrographic seizures, had an MTL resection on the more active side, continued RNS System treatment, and achieved a median clinical seizure reduction of 100% (mean: 90%; range: 50%-100%) at last follow-up, with eight of fifteen seizure-free. For those with more than 1 year of follow-up (N = 21), 15 patients (71%) were seizure-free during the most recent year, including all eight patients with unilateral onsets and 7 of 13 patients (54%) with bilateral onsets.

SIGNIFICANCE

Chronic ambulatory ICEEG data provide information about lateralization of MTL seizures and can identify additional patients who may benefit from MTL resection.

摘要

目的

描述在有双侧内侧颞叶（MTL）起始发作证据且基于直接脑反应性神经刺激器（RNS）系统的慢性动态颅内 EEG（ICEEG）数据接受 MTL 切除的药物难治性癫痫患者中的癫痫发作结局。

方法

我们回顾性地确定了 17 个癫痫中心的所有 MTL 癫痫患者，这些患者使用 RNS 系统进行双侧 MTL 导联治疗，随后进行了 MTL 切除。根据常规术前方法推测的偏侧性与 RNS 系统慢性动态 ICEEG 记录确定的偏侧性进行了比较。主要结局是与 MTL 切除前 3 个月的癫痫发作频率相比，MTL 切除后最后 3 个月的致残性癫痫发作频率。

结果

我们确定了 157 名因疑似双侧颞叶癫痫而使用 RNS 系统双侧 MTL 导联治疗的患者。25 名患者（16%）随后进行了 MTL 切除，这是基于慢性动态 ICEEG（平均 ICEEG 时间=42 个月）（25 名患者）；24 名患者可获得随访。MTL 切除后，最后随访时致残性癫痫发作的中位数减少 100%（平均：94%；范围：50%-100%）。9 名患者（38%）在慢性动态 ICEEG 中记录到单侧电发作，所有患者在 MTL 切除后最后随访时均无癫痫发作；其中 8 名患者继续接受 RNS 系统治疗。15 名患者（62%）有双侧 MTL 电发作，在更活跃的一侧进行 MTL 切除，继续接受 RNS 系统治疗，最后随访时的临床癫痫发作中位数减少 100%（平均：90%；范围：50%-100%），其中 8 名患者无癫痫发作。对于那些随访时间超过 1 年的患者（N=21），在最近一年中，15 名患者（71%）无癫痫发作，包括 8 名单侧发作患者和 13 名双侧发作患者中的 7 名（54%）。