Fields Madeline C, Eka Onome, Schreckinger Cristina, Dugan Patricia, Asaad Wael F, Blum Andrew S, Bullinger Katie, Willie Jon T, Burdette David E, Anderson Christopher, Quraishi Imran H, Gerrard Jason, Singh Anuradha, Lee Kyusang, Yoo Ji Yeoun, Ghatan Saadi, Panov Fedor, Marcuse Lara V
Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
St. Mary's Health Care System, Athens, GA, United States.
Front Neurol. 2023 Sep 8;14:1202631. doi: 10.3389/fneur.2023.1202631. eCollection 2023.
For drug resistant epilepsy patients who are either not candidates for resective surgery or have already failed resective surgery, neuromodulation is a promising option. Neuromodulatory approaches include responsive neurostimulation (RNS), deep brain stimulation (DBS), and vagal nerve stimulation (VNS). Thalamocortical circuits are involved in both generalized and focal onset seizures. This paper explores the use of RNS in the centromedian nucleus of the thalamus (CMN) and in the anterior thalamic nucleus (ANT) of patients with drug resistant epilepsy.
This is a retrospective multicenter study from seven different epilepsy centers in the United States. Patients that had unilateral or bilateral thalamic RNS leads implanted in the CMN or ANT for at least 6 months were included. Primary objectives were to describe the implant location and determine changes in the frequency of disabling seizures at 6 months, 1 year, 2 years, and > 2 years. Secondary objectives included documenting seizure free periods, anti-seizure medication regimen changes, stimulation side effects, and serious adverse events. In addition, the global clinical impression scale was completed.
Twelve patients had at least one lead placed in the CMN, and 13 had at least one lead placed in the ANT. The median baseline seizure frequency was 15 per month. Overall, the median seizure reduction was 33% at 6 months, 55% at 1 year, 65% at 2 years, and 74% at >2 years. Seizure free intervals of at least 3 months occurred in nine patients. Most patients (60%, 15/25) did not have a change in anti-seizure medications post RNS placement. Two serious adverse events were recorded, one related to RNS implantation. Lastly, overall functioning seemed to improve with 88% showing improvement on the global clinical impression scale.
Meaningful seizure reduction was observed in patients who suffer from drug resistant epilepsy with unilateral or bilateral RNS in either the ANT or CMN of the thalamus. Most patients remained on their pre-operative anti-seizure medication regimen. The device was well tolerated with few side effects. There were rare serious adverse events. Most patients showed an improvement in global clinical impression scores.
对于不适合进行切除性手术或切除性手术已失败的耐药性癫痫患者，神经调节是一种有前景的选择。神经调节方法包括反应性神经刺激（RNS）、深部脑刺激（DBS）和迷走神经刺激（VNS）。丘脑皮质回路参与全身性发作和局灶性发作。本文探讨了RNS在耐药性癫痫患者丘脑中央中核（CMN）和丘脑前核（ANT）中的应用。
这是一项来自美国七个不同癫痫中心的回顾性多中心研究。纳入了在CMN或ANT中植入单侧或双侧丘脑RNS电极至少6个月的患者。主要目标是描述植入位置，并确定6个月、1年、2年和>2年时致残性发作频率的变化。次要目标包括记录无癫痫发作期、抗癫痫药物治疗方案的变化、刺激副作用和严重不良事件。此外，还完成了整体临床印象量表。
12例患者至少有一根电极植入CMN，13例患者至少有一根电极植入ANT。基线发作频率中位数为每月15次。总体而言，6个月时发作减少中位数为33%，1年时为55%，2年时为65%，>2年时为74%。9例患者出现至少3个月的无癫痫发作期。大多数患者（60%，15/25）在RNS植入后抗癫痫药物没有变化。记录了两例严重不良事件，一例与RNS植入有关。最后，整体功能似乎有所改善，88%的患者在整体临床印象量表上显示有所改善。
在丘脑ANT或CMN中接受单侧或双侧RNS治疗的耐药性癫痫患者中观察到了有意义的发作减少。大多数患者维持术前抗癫痫药物治疗方案。该设备耐受性良好，副作用很少。严重不良事件罕见。大多数患者的整体临床印象评分有所改善。
