Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Ann Clin Transl Neurol. 2021 Jun;8(6):1353-1361. doi: 10.1002/acn3.51318. Epub 2021 May 6.
No clear evidence-based treatment paradigm currently exists for refractory and super-refractory status epilepticus, which can result in significant mortality and morbidity. While patients are typically treated with antiepileptic drugs and anesthetics, neurosurgical neuromodulation techniques can also be considered. We present a novel case in which responsive neurostimulation was used to effectively treat a patient who had developed super-refractory status epilepticus, later consistent with epilepsia partialis continua, that was refractory to antiepileptic drugs, immunomodulatory therapies, and transcranial magnetic stimulation. This case demonstrates how regional therapy provided by responsive neurostimulation can be effective in treating super-refractory status epilepticus through neuromodulation of seizure networks.
目前对于难治性和超难治性癫痫持续状态尚无明确的循证治疗模式,这可能导致严重的死亡率和发病率。虽然患者通常接受抗癫痫药物和麻醉药物治疗,但也可以考虑神经外科神经调节技术。我们报告了一个新病例,该患者在难治性癫痫持续状态后发展为超难治性癫痫持续状态,后来符合部分性癫痫持续状态,对抗癫痫药物、免疫调节治疗和经颅磁刺激均无反应,采用反应性神经刺激进行治疗,通过对癫痫网络的神经调节,有效地治疗了超难治性癫痫持续状态。该病例表明,反应性神经刺激提供的区域治疗通过对癫痫网络的神经调节可以有效治疗超难治性癫痫持续状态。