A Alomar Soha, J Saeedi Rothaina
Department of Surgery, Division of Neurosurgery, Faculty of Medicine, King Abdulaziz University, P.O. Box 80215, Jeddah, 21589, Saudi Arabia.
Neurol Sci. 2020 Dec;41(12):3527-3536. doi: 10.1007/s10072-020-04614-z. Epub 2020 Aug 1.
Epilepsy affects 1% of the general population, about one-third of which is pharmacologically resistant. Uncontrolled seizures are associated with an increased risk of traumatic injury and sudden unexpected death of epilepsy. There is a considerable psychological and financial burden on caregivers of patients with epilepsy, particularly among pediatric patients. Epilepsy surgery, when indicated, is the most promising cure for epilepsy. However, when surgery is contraindicated or refused by the patient, neurostimulation is an alternative palliative approach, albeit with a lower chance of entirely curing patients of seizures. There are many options for neurostimulation. The three most commonly used invasive neurostimulation procedures that consistently show evidence of being safe and efficacious are vagal nerve stimulation, responsive neuro stimulation, or anterior thalamic nucleus deep brain stimulation. The goal of this review is to summarize the current evidence supporting the use of these three techniques, which are approved by most regulatory bodies, and discuss different factors that may enable epilepsy surgeons to choose the most appropriate modality for each patient.
癫痫影响着1%的普通人群，其中约三分之一对药物治疗耐药。癫痫发作不受控制会增加外伤和癫痫猝死的风险。癫痫患者的照料者，尤其是儿童患者的照料者，承受着相当大的心理和经济负担。癫痫手术在有指征时是最有希望治愈癫痫的方法。然而，当手术被患者禁忌或拒绝时，神经刺激是一种替代的姑息治疗方法，尽管完全治愈患者癫痫发作的几率较低。神经刺激有多种选择。三种最常用的侵入性神经刺激程序，一直显示出安全有效的证据，它们是迷走神经刺激、反应性神经刺激或丘脑前核深部脑刺激。本综述的目的是总结支持使用这三种技术的现有证据，这三种技术已获得大多数监管机构的批准，并讨论不同因素，这些因素可能使癫痫外科医生为每位患者选择最合适的治疗方式。
