Tran Diem Kieu, Tran Demi Chi, Mnatsakayan Lilit, Lin Jack, Hsu Frank, Vadera Sumeet
Department of Neurological Surgery, University of California, Irvine, Irvine, CA, United States.
Department of Neurology, University of California, Irvine, Irvine, CA, United States.
Front Neurol. 2020 Oct 29;11:545074. doi: 10.3389/fneur.2020.545074. eCollection 2020.
Patients with medically refractory focal epilepsy can be difficult to treat surgically, especially if invasive monitoring reveals multiple ictal onset zones. Possible therapeutic options may include resection, neurostimulation, laser ablation, or a combination of these surgical modalities. To date, no study has examined outcomes associated with resection plus responsive neurostimulation (RNS, Neuropace, Inc., Mountain View, CA) implantation and we describe our initial experience in patients with multifocal epilepsy undergoing this combination therapy. A total of 43 responsive neurostimulation (RNS) devices were implanted at UCI from 2015 to 2019. We retrospectively reviewed charts of patients from the same time period who underwent both resection and RNS implantation. Patients were required to have independent or multifocal onset, undergo resection and RNS implantation, and have a minimum of six-months for follow-up to be included in the study. Demographics, location of ictal onset, location of surgery, complications, and seizure outcome were collected. Ten patients met inclusion criteria for the study, and seven underwent both procedures in the same setting. The average age was 36. All patients had multifocal ictal onset on video electroencephalogram or invasive EEG with four patients undergoing subdural grid placement and four patients undergoing bilateral sEEG prior to the definitive surgery. Five patients underwent resection plus ipsilateral RNS placement and the remainder underwent resection with contralateral RNS placement. Two minor complications were encountered in this group. At six months follow up, there was an average of 81% ± 9 reduction in seizures, while four patients experienced complete seizure freedom at 1 year. Patients with multifocal epilepsy can be treated with partial resection plus RNS. The complication rates are low with potential for worthwhile seizure reduction.
药物难治性局灶性癫痫患者的手术治疗可能具有挑战性，尤其是当侵入性监测显示存在多个发作起始区时。可能的治疗选择包括切除、神经刺激、激光消融或这些手术方式的联合应用。迄今为止，尚无研究探讨切除加反应性神经刺激（RNS，Neuropace公司，加利福尼亚州山景城）植入术的疗效，我们在此描述多灶性癫痫患者接受这种联合治疗的初步经验。2015年至2019年期间，加州大学欧文分校共植入了43个反应性神经刺激（RNS）装置。我们回顾性分析了同期接受切除和RNS植入的患者病历。纳入研究的患者需具备独立或多灶性发作起始、接受切除和RNS植入，且至少有6个月的随访时间。收集了患者的人口统计学资料、发作起始部位、手术部位、并发症及癫痫发作结果。10例患者符合研究纳入标准，其中7例在同一环境下接受了两种手术。平均年龄为36岁。所有患者在视频脑电图或侵入性脑电图检查中均表现为多灶性发作起始，其中4例患者在确定性手术前接受了硬膜下网格电极置入，4例患者接受了双侧立体定向脑电图检查。5例患者接受了切除加同侧RNS植入，其余患者接受了切除加对侧RNS植入。该组患者出现了2例轻微并发症。在6个月的随访中，癫痫发作平均减少了81%±9%，4例患者在1年时实现了癫痫发作完全缓解。多灶性癫痫患者可采用部分切除加RNS治疗。并发症发生率低，且有显著减少癫痫发作的潜力。
