Ryvlin Philippe, Jehi Lara E
Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland.
Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA.
Epilepsy Curr. 2021 Dec 15;22(1):11-17. doi: 10.1177/15357597211065587. eCollection 2022 Jan-Feb.
Three neuromodulation therapies, all using implanted device and electrodes, have been approved to treat adults with drug-resistant focal epilepsy, namely, the vagus nerve stimulation in 1995, deep brain stimulation of the anterior nucleus of the thalamus (ANT-DBS) in 2018 (2010 in Europe), and responsive neurostimulation (RNS) in 2014. Indications for VNS have more recently extended to children down to age of 4. Limited or anecdotal data are available in other epilepsy syndromes and refractory/super-refractory status epilepticus. Overall, neuromodulation therapies are palliative, with only a minority of patients achieving long-term seizure freedom, justifying favoring such treatments in patients who are not good candidates for curative epilepsy surgery. About half of patients implanted with VNS, ANT-DBS, and RNS have 50% or greater reduction in seizures, with long-term data suggesting increased efficacy over time. Besides their impact on seizure frequency, neuromodulation therapies are associated with various benefits and drawbacks in comparison to antiseizure drugs. Yet, we lack high-level evidence to best position each neuromodulation therapy in the treatment pathways of persons with difficult-to-treat epilepsy.
三种神经调节疗法均使用植入装置和电极，已被批准用于治疗耐药性局灶性癫痫的成人患者，即1995年的迷走神经刺激术、2018年（欧洲为2010年）的丘脑前核深部脑刺激术（ANT-DBS）以及2014年的反应性神经刺激术（RNS）。迷走神经刺激术的适应症最近已扩展至4岁及以上儿童。其他癫痫综合征和难治性/超难治性癫痫持续状态的相关数据有限或为轶事性资料。总体而言，神经调节疗法是姑息性的，只有少数患者能实现长期无癫痫发作，这使得在不适合进行根治性癫痫手术的患者中更倾向于采用此类治疗方法。植入迷走神经刺激术、丘脑前核深部脑刺激术和反应性神经刺激术的患者中约有一半癫痫发作减少了50%或更多，长期数据表明随着时间推移疗效会提高。与抗癫痫药物相比，神经调节疗法除了对癫痫发作频率有影响外，还存在各种利弊。然而，我们缺乏高级别证据来确定每种神经调节疗法在难治性癫痫患者治疗路径中的最佳位置。
