Department of Neurological Surgery, University of Chicago, Chicago, Illinois, USA.
Department of Neurology, University of Chicago, Chicago, Illinois, USA.
Stereotact Funct Neurosurg. 2023;101(3):195-206. doi: 10.1159/000529961. Epub 2023 May 22.
Stimulation of the thalamus is gaining favor in the treatment of medically refractory multifocal and generalized epilepsy. Implanted brain stimulators capable of recording ambulatory local field potentials (LFPs) have recently been introduced, but there is little information to guide their use in thalamic stimulation for epilepsy. This study sought to assess the feasibility of chronically recording ambulatory interictal LFP from the thalamus in patients with epilepsy.
In this pilot study, ambulatory LFP was recorded from patients who underwent sensing-enabled deep brain stimulation (DBS, 2 participants) or responsive neurostimulation (RNS, 3 participants) targeting the anterior nucleus of the thalamus (ANT, 2 electrodes), centromedian nucleus (CM, 7 electrodes), or medial pulvinar (PuM, 1 electrode) for multifocal or generalized epilepsy. Time-domain and frequency-domain LFP was investigated for epileptiform discharges, spectral peaks, circadian variation, and peri-ictal patterns.
Thalamic interictal discharges were visible on ambulatory recordings from both DBS and RNS. At-home interictal frequency-domain data could be extracted from both devices. Spectral peaks were noted at 10-15 Hz in CM, 6-11 Hz in ANT, and 19-24 Hz in PuM but varied in prominence and were not visible in all electrodes. In CM, 10-15 Hz power exhibited circadian variation and was attenuated by eye opening.
Chronic ambulatory recording of thalamic LFP is feasible. Common spectral peaks can be observed but vary between electrodes and across neural states. DBS and RNS devices provide a wealth of complementary data that have the potential to better inform thalamic stimulation for epilepsy.
刺激丘脑在治疗药物难治性多灶性和全身性癫痫中越来越受到青睐。最近引入了能够记录门诊局部场电位（LFPs）的植入式脑刺激器，但关于在丘脑刺激治疗癫痫中使用它们的信息很少。本研究旨在评估在癫痫患者中从丘脑进行慢性门诊间歇期 LFPs 记录的可行性。
在这项初步研究中，对接受深脑刺激（DBS，2 名参与者）或反应性神经刺激（RNS，3 名参与者）的患者进行了门诊 LFPs 记录，刺激靶点为丘脑前核（ANT，2 个电极）、中央中核（CM，7 个电极）或内侧丘觉核（PuM，1 个电极），用于多灶性或全身性癫痫。研究了时域和频域 LFPs 以检测癫痫样放电、频谱峰值、昼夜变化和发作期模式。
DBS 和 RNS 均可在门诊记录中观察到丘脑间歇期放电。可从两种设备中提取家庭式间歇期频域数据。在 CM 中观察到 10-15 Hz 的频谱峰值，在 ANT 中观察到 6-11 Hz 的频谱峰值，在 PuM 中观察到 19-24 Hz 的频谱峰值，但峰值的显著程度不同，并非所有电极都可见。在 CM 中，10-15 Hz 的功率表现出昼夜变化，并且在睁眼时会减弱。
慢性门诊记录丘脑 LFPs 是可行的。可以观察到常见的频谱峰值，但在电极之间和神经状态之间存在差异。DBS 和 RNS 设备提供了丰富的互补数据，有可能更好地为癫痫的丘脑刺激提供信息。
