Department of Neurological Surgery, Georgetown University School of Medicine, Washington, DC, USA.
Department of Neurosurgery, Children's National Hospital, Washington, DC, USA.
Clin Neurol Neurosurg. 2023 Dec;235:108041. doi: 10.1016/j.clineuro.2023.108041. Epub 2023 Nov 2.
Emerging neuromodulatory treatments, such as deep brain stimulation (DBS) and responsive neurostimulation (RNS), have shown promise in reducing drug-resistant seizures. While centromedian thalamic nucleus and anterior thalamic nucleus stimulation have been effective in certain types of seizures, limited research has explored pulvinar nucleus stimulation for epilepsy. To address this gap, we conducted a systematic review and individual patient data analysis. Of 78 resultant articles, 5 studies with transient stimulation and chronic stimulation of the pulvinar nucleus were included. Of the 20 patients reviewed, 65% of patients had temporal lobe seizures, while 20% had temporooccipital/occipital lobe seizures. Transient stimulation studies via stereoelectroencephalography (SEEG) showed pulvinar evoked potential response rates of 80% in the mesial temporal region, 76% in the temporal neocortex, and 67% in the TP junction. Another study reported clinically less severe seizures in 62.5% of patients with pulvinar stimulation. In chronic stimulation studies, 80% of patients responded to RNS or DBS, and 2 of 4 patients experienced > 90% seizure reduction. The pulvinar nucleus of the thalamus emerges as a potential target for chronic stimulation in drug-resistant epilepsy. However, knowledge regarding pulvinar connectivity and chronic stimulation remains limited. Further research should investigate specific subregions of the pulvinar for epilepsy treatment. Understanding the role of pulvinar stimulation and its cortical connectivity will advance therapeutic interventions for epilepsy patients.
新兴的神经调节治疗方法，如深部脑刺激（DBS）和反应性神经刺激（RNS），已显示出在减少耐药性癫痫发作方面的潜力。虽然中央中核和前丘脑核刺激在某些类型的癫痫发作中是有效的，但对丘脑枕核刺激治疗癫痫的研究有限。为了解决这一差距，我们进行了系统评价和个体患者数据分析。在 78 篇相关文章中，有 5 篇研究包括了丘脑枕核的短暂刺激和慢性刺激。在 20 名被审查的患者中，65%的患者有颞叶癫痫发作，20%的患者有颞枕叶/枕叶癫痫发作。通过立体脑电图（SEEG）进行的短暂刺激研究显示，在颞叶内侧，丘脑枕核诱发的电响应率为 80%；在颞叶新皮质为 76%；在 TP 交界处为 67%。另一项研究报告称，丘脑枕核刺激使 62.5%的患者癫痫发作程度减轻。在慢性刺激研究中，80%的患者对 RNS 或 DBS 有反应，4 名患者中有 2 名的癫痫发作减少了>90%。丘脑的丘脑枕核作为耐药性癫痫慢性刺激的潜在靶点出现。然而，关于丘脑枕核连接和慢性刺激的知识仍然有限。进一步的研究应该调查丘脑枕核治疗癫痫的特定亚区。了解丘脑枕核刺激及其皮质连接的作用将为癫痫患者的治疗干预提供进展。
