Freigang Sascha, Jiménez-Jiménez Diego, Kazi Farhana, Díaz-Díaz Judit, Pina Marisa, Cunha Maria, Alarcón Gonzalo, Selway Richard P, Valentín Antonio
Department of Basic & Clinical Neuroscience, King's College London, Institute of Psychiatry, Psychology and Neuroscience London, UK; Department of Neurosurgery, Medical University Graz, Austria.
Department of Basic & Clinical Neuroscience, King's College London, Institute of Psychiatry, Psychology and Neuroscience London, UK; Department of Clinical Neurophysiology, King's College Hospital NHS FT, London, UK; Universidad San Francisco De Quito, School of Medicine, Quito, Ecuador; National Hospital for Neurology and Neurosurgery, University College London Hospitals National Health Service Foundation Trust, London, UK; The Chalfont Centre for Epilepsy, Chalfont St Peter, UK.
Epilepsy Res. 2020 Oct;166:106392. doi: 10.1016/j.eplepsyres.2020.106392. Epub 2020 Jun 8.
Chronic intracranial electrical stimulation is now widely used as treatment for drug resistant epilepsy. Subacute neocortical stimulation (SNCS) can also be performed during EEG recordings with intracranial electrodes (iEEG), but its diagnostic value remains largely unknown.
We assessed the effects of SNCS on the frequency of seizures and epileptiform discharges (EDs) during 290 h of iEEG- from 12 patients (6 adults, 6 children) with epilepsy secondary to focal cortical dysplasia (FCD).
In 9/12 patients, SNCS periods showed decreased seizure-frequency (Median -73 %, p = 0.0093). At baseline, incidence of EDs were correlated with seizure-frequency (Spearman r = 0.59). However, this correlation disappeared during SNCS and a significant change in the incidence of EDs was observed. In addition, there was a trend towards greater reduction in seizure-frequency during SNCS in patients who underwent surgery.
In summary, SNCS can reduce seizure-frequency and changes ED-frequency. The variability in ED changes may be explained by different effects of SNCS depending on electrode location. The magnitude of seizure reduction during SNCS suggests that this technique could contribute to preoperative assessment in epilepsy surgery.
慢性颅内电刺激目前被广泛用作耐药性癫痫的治疗方法。亚急性新皮质刺激（SNCS）也可在使用颅内电极（iEEG）进行脑电图记录时进行，但其诊断价值在很大程度上仍不清楚。
我们评估了SNCS对12例继发于局灶性皮质发育不良（FCD）的癫痫患者（6名成人，6名儿童）290小时iEEG期间癫痫发作频率和癫痫样放电（EDs）的影响。
在12例患者中的9例中，SNCS期间癫痫发作频率降低（中位数-73%，p = 0.0093）。在基线时，EDs的发生率与癫痫发作频率相关（Spearman r = 0.59）。然而，这种相关性在SNCS期间消失，并且观察到EDs发生率有显著变化。此外，接受手术的患者在SNCS期间癫痫发作频率有更大降低的趋势。
总之，SNCS可以降低癫痫发作频率并改变ED频率。ED变化的变异性可能由SNCS根据电极位置的不同效应来解释。SNCS期间癫痫发作减少的幅度表明该技术可能有助于癫痫手术的术前评估。
