Children's Hospital Boston, Boston, MA, USA.
Floating Hospital for Children at Tufts Medical Center, Boston, MA, USA.
Clin Ther. 2020 Jul;42(7):1140-1154. doi: 10.1016/j.clinthera.2020.05.017. Epub 2020 Jun 30.
Neuromodulation holds great promise for the treatment of drug-resistant epilepsy. This article reviews the most common types of neuromodulation as well as potential future applications of preclinical techniques such as optogenetics. This review serves as a reference for treating neurologists on the latest science behind such treatment approaches.
This narrative review briefly describes the preclinical and clinical history of each technique, with a special emphasis on, wherever possible, strong clinical evidence and any available data from pediatric populations. A detailed literature review was performed for each method of neuromodulation.
Since the concept of electrical stimulation as a treatment for neurologic conditions emerged in the early 19th century, neuromodulatory techniques using direct or induced electrical currents have been developed to reduce seizure frequency and duration in patients with drug-resistant epilepsy. This article reviews the applications, clinical guidelines, outcomes, and proposed mechanisms of available approaches, including vagus nerve stimulation, responsive neurostimulation, deep brain stimulation, and transcranial stimulation. Although promising outcomes have been achieved in adults and children with drug-resistant epilepsy, heterogeneity among epilepsy types and etiologies, optimization of stimulation parameters, and a lack of direct comparisons between neuromodulatory approaches are challenges that have yet to be overcome.
Neuromodulation is a rapidly evolving field in clinical neuroscience that has treatment implications in a variety of clinical arenas, with epilepsy among the most important of those. It offers the promise of delivering effective treatment for drug-resistant epilepsy, with potentially fewer side effects than standard surgical approaches. © 2020 Elsevier HS Journals, Inc.
神经调节在治疗耐药性癫痫方面具有广阔的前景。本文综述了最常见的神经调节类型，以及光遗传学等临床前技术的潜在未来应用。本文旨在为治疗神经科医生提供有关此类治疗方法最新科学的参考。
本叙述性综述简要描述了每种技术的临床前和临床历史，特别强调了尽可能具有强大临床证据和任何来自儿科人群的可用数据。对每种神经调节方法进行了详细的文献复习。
自 19 世纪初出现电刺激作为治疗神经系统疾病的概念以来，已经开发出使用直接或诱导电流的神经调节技术，以减少耐药性癫痫患者的癫痫发作频率和持续时间。本文综述了现有的应用、临床指南、结果和提出的机制，包括迷走神经刺激、反应性神经刺激、深部脑刺激和经颅刺激。尽管在耐药性癫痫的成人和儿童中取得了有希望的结果，但癫痫类型和病因的异质性、刺激参数的优化以及神经调节方法之间缺乏直接比较仍然是尚未克服的挑战。
神经调节是临床神经科学中一个快速发展的领域，在各种临床领域都具有治疗意义，其中最重要的是癫痫。它为耐药性癫痫提供了有效的治疗方法的可能性，其潜在的副作用可能比标准手术方法少。©2020 Elsevier HS 期刊，Inc.
