Department of Neurology and Pediatrics, Emory University School of Medicine, Atlanta, GA 30329, USA.
NeuroPace, Inc., Mountain View, CA, USA.
Epilepsy Behav. 2021 Apr;117:107868. doi: 10.1016/j.yebeh.2021.107868. Epub 2021 Mar 5.
To establish whether earlier treatment using direct brain-responsive neurostimulation for medically intractable focal-onset seizures is associated with better mood and Quality of Life (QoL) compared to later treatment intervention.
Data were retrospectively analyzed from prospective clinical trials of a direct brain-responsive neurostimulator (RNS® System) for treatment of adults with medically intractable focal-onset epilepsy. Participants completed the Quality of Life in Epilepsy Inventory (QOLIE-31) yearly through 9 years of follow-up and the Beck Depression Inventory-II (BDI-II) through 2 years of follow-up. Changes in each assessment after treatment with responsive neurostimulation were calculated for patients who began treatment within 10 years of seizure onset (early) and those who began treatment 20 years or more after seizure onset (late).
The median duration of epilepsy was 18.3 years at enrollment. At 9 years, both the early (N = 51) and late (N = 109) treatment groups experienced similar and significant reductions in the frequency of disabling seizures (73.4% and 77.8%, respectively). The early treatment patients had significant improvements in QoL and mood. However, the late treatment patients not only failed to show these improvements but also declined in the emotional QoL subscale.
Patients treated with brain-responsive neurostimulation earlier in the course of their epilepsy show significant improvements in multiple domains of QoL and mood that are not observed in patients treated later in the course of their epilepsy despite similar efficacy in seizure reduction. Even with similar and substantial reductions in seizure frequency, the comorbidities of uncontrolled epilepsy may be less responsive to treatment when too many years have passed. The results of this study suggest that, as with resective and ablative surgery, treatment with brain-responsive neurostimulation should be delivered as early as possible in the course of medically resistant epilepsy to maximize the opportunity for improvements in mood and QoL.
比较直接脑反应性神经刺激在药物难治性局灶性发作中的早期治疗与晚期治疗干预，观察前者是否对患者情绪和生活质量（QoL）有更好的影响。
对一种直接脑反应性神经刺激器（RNS®系统）治疗药物难治性局灶性癫痫的前瞻性临床试验数据进行回顾性分析。患者在 9 年的随访中每年通过癫痫生活质量量表（QOLIE-31）评估，在 2 年的随访中通过贝克抑郁量表第二版（BDI-II）评估。对发病 10 年内（早期）和 20 年或以上（晚期）开始治疗的患者，计算治疗后各评估的变化。
入组时癫痫的中位病程为 18.3 年。9 年时，早期（N=51）和晚期（N=109）治疗组的致残性癫痫发作频率均显著降低（分别为 73.4%和 77.8%）。早期治疗患者的 QoL 和情绪明显改善。但晚期治疗患者不仅没有出现这些改善，情绪 QoL 亚量表反而下降。
在癫痫病程早期接受脑反应性神经刺激治疗的患者，在 QoL 和情绪的多个领域均有显著改善，而在癫痫病程晚期接受治疗的患者则没有这些改善，尽管在减少癫痫发作方面效果相似。即使癫痫发作频率有类似且显著的降低，当病程迁延太久，未经控制的癫痫的合并症对治疗的反应可能较差。本研究结果表明，与切除性和消融性手术一样，脑反应性神经刺激治疗应尽早在药物难治性癫痫的病程中进行，以最大限度地提高改善情绪和 QoL 的机会。
