Hoffman Caitlin E, Parker Whitney E, Rapoport Benjamin I, Zhao Mingrui, Ma Hongtao, Schwartz Theodore H
Department of Neurological Surgery, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York, USA.
Department of Neurological Surgery, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York, USA.
World Neurosurg. 2020 Jul;139:775-788. doi: 10.1016/j.wneu.2020.03.031.
Technical limitations and clinical challenges have historically limited the diagnostic tools and treatment methods available for surgical approaches to the management of epilepsy. By contrast, recent technological innovations in several areas hold significant promise in improving outcomes and decreasing morbidity. We review innovations in the neurosurgical management of epilepsy in several areas, including wireless recording and stimulation systems (particularly responsive neurostimulation [NeuroPace]), conformal electrodes for high-resolution electrocorticography, robot-assisted stereotactic surgery, optogenetics and optical imaging methods, novel positron emission tomography ligands, and new applications of focused ultrasonography. Investigation into genetic causes of and susceptibilities to epilepsy has introduced a new era of precision medicine, enabling the understanding of cell signaling mechanisms underlying epileptic activity as well as patient-specific molecularly targeted treatment options. We discuss the emerging path to individualized treatment plans, predicted outcomes, and improved selection of effective interventions, on the basis of these developments.
从历史上看，技术限制和临床挑战一直限制着用于癫痫外科治疗方法的诊断工具和治疗手段。相比之下，近期多个领域的技术创新在改善治疗效果和降低发病率方面具有巨大潜力。我们回顾了癫痫神经外科治疗在几个领域的创新，包括无线记录和刺激系统（特别是反应性神经刺激[NeuroPace]）、用于高分辨率皮层脑电图的适形电极、机器人辅助立体定向手术、光遗传学和光学成像方法、新型正电子发射断层扫描配体以及聚焦超声的新应用。对癫痫的遗传病因和易感性的研究开启了精准医学的新时代，有助于理解癫痫活动背后的细胞信号机制以及针对患者的分子靶向治疗方案。基于这些进展，我们讨论了制定个性化治疗方案、预测治疗效果以及改进有效干预措施选择的新途径。
