Wang Shu, Zhao Meng, Li Tianfu, Zhang Chunsheng, Zhou Jian, Wang Mengyang, Wang Xiongfei, Ma Kaiqiang, Luan Guoming, Guan Yuguang
Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing, 100093, China.
Department of Neurology, SanBo Brain Hospital, Capital Medical University, Beijing, 100093, China.
Neurol Sci. 2021 Jan;42(1):225-233. doi: 10.1007/s10072-020-04554-8. Epub 2020 Jul 6.
Temporal lobe epilepsy patients treated with hippocampal deep brain stimulation (Hip-DBS) have rarely been reported before. Preoperative and postoperative cognitive function is seldom analyzed.
Seven patients with drug-resistant temporal lobe epilepsy were included in this study. Bilateral Hip-DBS was performed in these patients. The stimulator was activated 1 month after the implantation. Then, the patients returned for further adjustments 4 months after the surgery and reprogramming every year. The seizure frequency, Wechsler Adult Intelligence Scale-IV, and Wechsler memory scale-IV were assessed blindly as the outcomes at each follow-up.
After a mean 48-month follow-up, the mean seizure frequency significantly decreased (p = 0.011, paired t test; decrease of 78.1%). One patient (14.3%) was seizure-free by the last follow-up; six of seven (85.7%) patients had reductions in seizure frequency of at least 50%; one patient (14.3%) who did not comply with the antiepileptic drug instructions had a less than 50% reduction in seizure frequency. In addition, there were no significant decreases in intelligence or verbal and visual memory from baseline to the last follow-up (p = 0.736, paired t test; p = 0.380, paired t test, respectively).
Hip-DBS could provide acceptable long-term efficacy and safety. For patients with drug-resistant temporal lobe epilepsy who are not suitable for resective surgery, Hip-DBS could become a potential therapeutic option.
此前很少有关于接受海马深部脑刺激（Hip-DBS）治疗的颞叶癫痫患者的报道。术前和术后认知功能很少被分析。
本研究纳入7例耐药性颞叶癫痫患者。对这些患者实施双侧Hip-DBS。植入后1个月激活刺激器。然后，患者在术后4个月复诊以进一步调整，并每年进行重新程控。在每次随访时，对癫痫发作频率、韦氏成人智力量表第四版（WAIS-IV）和韦氏记忆量表第四版（WMS-IV）进行盲法评估作为结果。
平均随访48个月后，平均癫痫发作频率显著降低（p = 0.011，配对t检验；降低78.1%）。1例患者（14.3%）在最后一次随访时无癫痫发作；7例患者中的6例（85.7%）癫痫发作频率降低至少50%；1例未遵守抗癫痫药物医嘱的患者癫痫发作频率降低不到50%。此外，从基线到最后一次随访，智力、言语和视觉记忆均无显著下降（分别为p = 0.736，配对t检验；p = 0.380，配对t检验）。
Hip-DBS可提供可接受的长期疗效和安全性。对于不适合切除性手术的耐药性颞叶癫痫患者，Hip-DBS可能成为一种潜在的治疗选择。
