Simula Sara, Daoud Maëva, Ruffini Giulio, Biagi Maria Chiara, Bénar Christian-G, Benquet Pascal, Wendling Fabrice, Bartolomei Fabrice
Aix Marseille Univ, INSERM, INS, Int Neurosci Syst, Marseille, France.
Neuroelectrics Barcelona, Barcelona, Spain.
Front Neurosci. 2022 Aug 25;16:909421. doi: 10.3389/fnins.2022.909421. eCollection 2022.
Transcranial electrical current stimulation (tES or tCS, as it is sometimes referred to) has been proposed as non-invasive therapy for pharmacoresistant epilepsy. This technique, which includes direct current (tDCS) and alternating current (tACS) stimulation involves the application of weak currents across the cortex to change cortical excitability. Although clinical trials have demonstrated the therapeutic efficacy of tES, its specific effects on epileptic brain activity are poorly understood. We sought to summarize the clinical and fundamental effects underlying the application of tES in epilepsy.
A systematic review was performed in accordance with the PRISMA guidelines. A database search was performed in PUBMED, MEDLINE, Web of Science and Cochrane CENTRAL for articles corresponding to the keywords "".
A total of 56 studies were included in this review. Through these records, we show that tDCS and tACS epileptic patients are safe and clinically relevant techniques for epilepsy. Recent articles reported changes of functional connectivity in epileptic patients after tDCS. We argue that tDCS may act by affecting brain networks, rather than simply modifying local activity in the targeted area. To explain the mechanisms of tES, various cellular effects have been identified. Among them, reduced cell loss, mossy fiber sprouting, and hippocampal BDNF protein levels. Brain modeling and human studies highlight the influence of individual brain anatomy and physiology on the electric field distribution. Computational models may optimize the stimulation parameters and bring new therapeutic perspectives.
Both tDCS and tACS are promising techniques for epilepsy patients. Although the clinical effects of tDCS have been repeatedly assessed, only one clinical trial has involved a consistent number of epileptic patients and little knowledge is present about the clinical outcome of tACS. To fill this gap, multicenter studies on tES in epileptic patients are needed involving novel methods such as personalized stimulation protocols based on computational modeling. Furthermore, there is a need for more studies replicating the tES parameters applied in patients. Finally, there is a lack of clinical studies investigating changes in intracranial epileptiform discharges during tES application, which could clarify the nature of tES-related local and network dynamics in epilepsy.
经颅电流刺激（tES 或有时所称的 tCS）已被提议作为药物难治性癫痫的非侵入性治疗方法。该技术包括直流电（tDCS）和交流电（tACS）刺激，涉及在皮层上施加弱电流以改变皮层兴奋性。尽管临床试验已证明 tES 的治疗效果，但其对癫痫脑活动的具体影响仍知之甚少。我们试图总结 tES 在癫痫应用中的临床和基础效应。
按照 PRISMA 指南进行系统评价。在 PUBMED、MEDLINE、Web of Science 和 Cochrane CENTRAL 中进行数据库检索，以查找与关键词“”对应的文章。
本综述共纳入 56 项研究。通过这些记录，我们表明 tDCS 和 tACS 对癫痫患者是安全且与临床相关的技术。近期文章报道了 tDCS 后癫痫患者功能连接的变化。我们认为 tDCS 可能通过影响脑网络起作用，而不是简单地改变目标区域的局部活动。为了解释 tES 的机制，已确定了各种细胞效应。其中包括减少细胞损失、苔藓纤维发芽和海马脑源性神经营养因子（BDNF）蛋白水平。脑模型和人体研究突出了个体脑解剖结构和生理对电场分布的影响。计算模型可优化刺激参数并带来新的治疗前景。
tDCS 和 tACS 对癫痫患者都是有前景的技术。尽管已多次评估 tDCS 的临床效果，但仅有一项临床试验纳入了数量一致的癫痫患者，且对 tACS 的临床结果了解甚少。为填补这一空白，需要开展针对癫痫患者的 tES 多中心研究，采用基于计算模型的个性化刺激方案等新方法。此外，需要更多研究复制应用于患者的 tES 参数。最后，缺乏临床研究调查 tES 应用期间颅内癫痫样放电的变化，这可能阐明癫痫中与 tES 相关的局部和网络动力学的性质。
