Department of Neurological Surgery, University of Alabama at Birmingham, Birmingham, AL, USA; Vivian L. Smith Department of Neurosurgery, McGovern Medical School at UT Health Houston, Houston, TX, USA; Texas Institute for Restorative Neurotechnologies, The University of Texas Health Science Center at Houston, Houston, TX, USA.
Vivian L. Smith Department of Neurosurgery, McGovern Medical School at UT Health Houston, Houston, TX, USA; Texas Institute for Restorative Neurotechnologies, The University of Texas Health Science Center at Houston, Houston, TX, USA; Department of Neurology, McGovern Medical School at UT Health Houston, Houston, TX, USA; Memorial Hermann Hospital, Texas Medical Center, Houston, TX, USA.
Epilepsy Res. 2022 Jul;183:106942. doi: 10.1016/j.eplepsyres.2022.106942. Epub 2022 May 11.
Thalamic neuromodulation can be an effective therapeutic option for select patients with medically refractory epilepsy. However, successful outcome depends on several factors, beginning with appropriate patient and thalamic target selection. Among thalamic targets, the anterior (ANT) and centromedian (CeM) nuclei have the greatest clinical evidence for efficacy. However, the place of thalamic neuromodulation in the treatment armamentarium for intractable seizures is at the tail end of a long list of options. It's relative efficacy, if any, in relation to other treatment modalities however, can be inferred. As we will discuss, considerable work remains to be done in optimal targeting of thalamic nuclei, appropriate to the epilepsy syndrome and seizure type of the individual patient, which may change our current understanding of the place of thalamic neuromodulation on a range of treatment modality efficacies. Currently, it appears that ANT DBS is most efficacious for limbic epilepsies whereas CM, for generalized, multifocal (especially frontotemporal) epilepsies. Based on controlled studies, the efficacy of ANT and CeM DBS is roughly in line with other neuromodulatory therapies (i.e. RNS, VNS) when assessed within the cohort of patients for which the therapy is indicated. Much improvement is needed to render thalamic DBS more efficacious, and use of optimal targeting strategies, especially direct targeting, can positively affect outcomes. Thalamic neuromodulation is still in its infancy; however, clinical advances in this therapy are being realized.
丘脑神经调节可以成为治疗某些药物难治性癫痫患者的有效选择。然而，成功的结果取决于几个因素，首先是选择合适的患者和丘脑靶点。在丘脑靶点中，前核（ANT）和中央中核（CeM）在疗效方面具有最大的临床证据。然而，丘脑神经调节在治疗难治性癫痫发作的手段中处于一系列选择的末尾。然而，可以推断出它与其他治疗方式相比的相对疗效。正如我们将讨论的那样，仍需要在最佳靶向丘脑核方面进行大量工作，以适应个体患者的癫痫综合征和发作类型，这可能会改变我们目前对丘脑神经调节在一系列治疗方式疗效中的地位的理解。目前，ANT-DBS 似乎对边缘性癫痫最有效，而 CM 对全身性、多灶性（特别是额颞叶）癫痫最有效。基于对照研究，当在治疗适应证的患者队列中评估时，ANT 和 CeM-DBS 的疗效与其他神经调节疗法（即 RNS、VNS）大致相当。需要进行大量改进才能使丘脑 DBS 更有效，并且使用最佳靶向策略，特别是直接靶向，可以对结果产生积极影响。丘脑神经调节仍处于起步阶段；然而，该疗法的临床进展正在实现。
