Department of Neurology, Center for Neuro-engineering and Therapeutics, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A.
Department of Neurology, Division of Epilepsy, Uniformed Services University of the Health Sciences, Bethesda, Maryland, U.S.A.
J Clin Neurophysiol. 2022 Feb 1;39(2):e5-e9. doi: 10.1097/WNP.0000000000000870.
The vagus nerve stimulator (VNS) and responsive nerve stimulator (RNS) are nonpharmacological devices approved for drug-resistant epilepsy. Vagus nerve stimulator was removed before placing an RNS in clinical trials. Two cases of bilateral mesial temporal epilepsy treated concurrently with VNS and bilateral mesial temporal RNS devices were reported. In each case, the VNS device was turned off temporarily, which allowed for a direct comparison of RNS recordings and efficacy with and without simultaneous VNS stimulation. Temporary VNS cessation lead to increased clinical and electrocorticographic seizures despite continued anti-seizure drugs and RNS stimulation. In one case, VNS eliminated seizures from one epileptogenic area, whereas VNS and RNS were required to treat seizures from the contralateral mesial temporal structure. In another case, VNS effectively decreased seizure spread to the symptomatogenic zone. These cases demonstrate synergistic neuromodulation with concurrent use of VNS and RNS in intractable bitemporal epilepsy.
迷走神经刺激器 (VNS) 和反应性神经刺激器 (RNS) 是用于治疗耐药性癫痫的非药物性设备。在临床试验中放置 RNS 之前，会先移除迷走神经刺激器。报告了两例同时使用双侧海马 RNS 设备治疗双侧海马内侧颞叶癫痫的病例。在每种情况下，VNS 设备都会被暂时关闭，以便可以直接比较 RNS 记录和有效性，以及是否同时进行 VNS 刺激。尽管继续使用抗癫痫药物和 RNS 刺激，但 VNS 的暂时停用导致临床和皮质脑电图发作增加。在一个病例中，VNS 消除了一个致痫区的发作，而 VNS 和 RNS 则需要治疗对侧海马内侧结构的发作。在另一个病例中，VNS 有效地减少了癫痫发作向症状发生区的扩散。这些病例表明，在难治性双侧颞叶癫痫中，同时使用 VNS 和 RNS 具有协同的神经调节作用。
