Olaciregui Dague Karmele, Witt Juri-Alexander, von Wrede Randi, Helmstaedter Christoph, Surges Rainer
Department of Epileptology, University Hospital Bonn, Bonn, Germany.
Front Neurol. 2023 Mar 9;14:1106511. doi: 10.3389/fneur.2023.1106511. eCollection 2023.
Evaluation of the antiseizure efficacy, side effects and neuropsychological effects of Deep brain stimulation (DBS) of the anterior nucleus of the thalamus (ANT). ANT-DBS is a treatment option for patients with difficult-to-treat epilepsy. Though several works outline the cognitive and/or mood effects of ANT-DBS for the treatment of epilepsy, data on the intersection between antiseizure efficacy, cognitive and undesired effects are scarce.
We retrospectively analyzed the data of our cohort of 13 patients. Post-implantation seizure frequencies were measured at 6 months, 12 months and last follow-up, as well as averaged throughout follow-up. These values were then compared with mean seizure frequencies in the 6 months before implantation. To address acute cognitive effects of DBS a baseline assessment was performed after implantation and before stimulation, and a follow-up assessment was conducted under DBS. The long-term effects of DBS on cognition were assessed by comparing the preoperative neuropsychological profile with a long-term follow-up under DBS.
In the entire cohort, 54.5% of patients were responders, with an average seizure reduction of 73.6%. One of these patients achieved temporary seizure freedom and near-total seizure reduction during the entire follow-up. Seizure reduction of <50% was achieved in 3 patients. Non-responders suffered an average seizure increase of 27.3%. Eight of twenty-two active electrodes (36,4%) were off-target. Two of our patients had both electrodes implanted off-target. When removing these two patients from the analysis and averaging seizure frequency during the entire follow-up period, four patients (44.4%) were responders and three experienced a seizure reduction of <50%. Intolerable side effects arose in 5 patients, mostly psychiatric. Regarding acute cognitive effects of DBS, only one patient showed a significant decline in executive functions. Long-term neuropsychological effects included significant intraindividual changes in verbal learning and memory. Figural memory, attention and executive functions, confrontative naming and mental rotation were mostly unchanged, and improved in few cases.
In our cohort, more than half of patients were responders. Psychiatric side effects seem to have been more prevalent compared to other published cohorts. This may be partially explained by a relatively high occurrence of off-target electrodes.
评估丘脑前核（ANT）的深部脑刺激（DBS）的抗癫痫疗效、副作用及神经心理学效应。ANT-DBS是难治性癫痫患者的一种治疗选择。尽管有几项研究概述了ANT-DBS治疗癫痫的认知和/或情绪效应，但关于抗癫痫疗效、认知和不良效应之间交叉的数据却很少。
我们回顾性分析了13例患者队列的数据。在植入后6个月、12个月及末次随访时测量癫痫发作频率，并计算整个随访期间的平均发作频率。然后将这些值与植入前6个月的平均发作频率进行比较。为了评估DBS的急性认知效应，在植入后且未刺激前进行了基线评估，并在DBS状态下进行了随访评估。通过比较术前神经心理学特征与DBS长期随访结果来评估DBS对认知的长期影响。
在整个队列中，54.5%的患者为反应者，平均癫痫发作减少73.6%。其中1例患者在整个随访期间实现了短暂的无癫痫发作和近乎完全的发作减少。3例患者的癫痫发作减少<50%。无反应者的癫痫发作平均增加27.3%。22个有源电极中有8个（36.4%）靶点错误。我们的2例患者植入的两个电极均靶点错误。将这2例患者从分析中剔除并计算整个随访期间的平均发作频率后，4例患者（44.4%）为反应者，3例患者的癫痫发作减少<50%。5例患者出现了无法耐受的副作用，主要是精神方面的。关于DBS的急性认知效应，只有1例患者的执行功能出现了显著下降。长期神经心理学效应包括言语学习和记忆方面个体内的显著变化。图形记忆、注意力和执行功能、对答命名和心理旋转大多未改变，少数情况有所改善。
在我们的队列中，超过一半的患者为反应者。与其他已发表的队列相比，精神方面的副作用似乎更为普遍。这可能部分归因于靶点错误电极的发生率相对较高。
