Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA.
Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA.
Epilepsia. 2022 Sep;63(9):2290-2300. doi: 10.1111/epi.17331. Epub 2022 Jul 5.
Based on the promising results of randomized controlled trials, deep brain stimulation (DBS) and responsive neurostimulation (RNS) are used increasingly in the treatment of patients with drug-resistant epilepsy. Drug-resistant temporal lobe epilepsy (TLE) is an indication for either DBS of the anterior nucleus of the thalamus (ANT) or temporal lobe (TL) RNS, but there are no studies that directly compare the seizure benefits and adverse effects associated with these therapies in this patient population. We, therefore, examined all patients who underwent ANT-DBS or TL-RNS for drug-resistant TLE at our center.
We performed a retrospective review of patients who were treated with either ANT-DBS or TL-RNS for drug-resistant TLE with at least 12 months of follow-up. Along with the clinical characteristics of each patient's epilepsy, seizure frequency was recorded throughout each patient's postoperative clinical course.
Twenty-six patients underwent ANT-DBS implantation and 32 patients underwent TL-RNS for drug-resistant TLE. The epilepsy characteristics of both groups were similar. Patients who underwent ANT-DBS demonstrated a median seizure reduction of 58% at 12-15 months, compared to a median seizure reduction of 70% at 12-15 months in patients treated with TL-RNS (p > .05). The responder rate (percentage of patients with a 50% decrease or more in seizure frequency) was 54% for ANT-DBS and 56% for TL-RNS (p > .05). The incidence of complications and stimulation-related side effects did not significantly differ between therapies.
We demonstrate in our single-center experience that patients with drug-resistant TLE benefit similarly from either ANT-DBS or TL-RNS. Selection of either ANT-DBS or TL-RNS may, therefore, depend more heavily on patient and provider preference, as each has unique capabilities and configurations. Future studies will consider subgroup analyses to determine if specific patients have greater seizure frequency reduction from one form of neuromodulation strategy over another.
基于随机对照试验的良好结果，深部脑刺激（DBS）和反应性神经刺激（RNS）越来越多地用于治疗耐药性癫痫患者。耐药性颞叶癫痫（TLE）是丘脑前核（ANT）DBS 或颞叶（TL）RNS 的适应证，但没有研究直接比较这些治疗方法在该患者人群中的癫痫获益和不良反应。因此，我们检查了在我们中心接受 ANT-DBS 或 TL-RNS 治疗耐药性 TLE 的所有患者。
我们对在我们中心接受 ANT-DBS 或 TL-RNS 治疗耐药性 TLE 且至少有 12 个月随访的患者进行了回顾性研究。除了每位患者癫痫的临床特征外，还记录了每位患者术后临床过程中的癫痫发作频率。
26 例患者接受 ANT-DBS 植入，32 例患者接受 TL-RNS 治疗耐药性 TLE。两组患者的癫痫特征相似。接受 ANT-DBS 的患者在 12-15 个月时癫痫发作减少了 58%，而接受 TL-RNS 治疗的患者在 12-15 个月时癫痫发作减少了 70%（p>.05）。ANT-DBS 的应答率（癫痫发作频率降低 50%或更多的患者百分比）为 54%，TL-RNS 为 56%（p>.05）。并发症和刺激相关副作用的发生率在两种治疗方法之间无显著差异。
我们在单中心经验中证明，耐药性 TLE 患者从 ANT-DBS 或 TL-RNS 中获益相似。因此，ANT-DBS 或 TL-RNS 的选择可能更多地取决于患者和提供者的偏好，因为每种方法都具有独特的功能和配置。未来的研究将考虑亚组分析，以确定是否特定患者从一种神经调节策略中获得更大的癫痫发作频率降低。
