Sandoval-Bonilla Bayron Alexander, Vargas María Fabiola De la Cerda, Nuñez Maximiliano Alberto, Parpaley Yaroslav, Codeiro Joacir Graciolli, Cosio Jesus Fonseca, de la Torre Ramiro Antonio Perez, Garcia-Muñoz Luis
Associate Professor of Neurosurgery, Department of Neurosurgery, Functional NeuroOncology and Epilepsy Surgery Multidisciplinary Board, CMN Siglo XXI, IMSS, Mexico City, Mexico.
Department of Neurosurgery and Neurotechnology, Universitätsklinik Tübingen, Tübingen, Germany.
Surg Neurol Int. 2024 Apr 5;15:124. doi: 10.25259/SNI_911_2023. eCollection 2024.
This report aims to describe the neuromodulation effect on seizure control in a patient with a left hippocampal migrated electrode to the Posterior Sylvian Junction (PSJ) during a follow-up of 17 years.
We report a case of a female patient with drug-resistant epilepsy who initiated at seven years old and underwent a stereotactic frame-based insertion of a left hippocampal electrode for deep brain stimulation (DBS). Posterior migration of the electrode was identified at PSJ by postoperative magnetic resonance imaging one month after surgery. A consistent seizure reduction (Engel IC) was obtained with 2v-120 uS-145 Hz, contacts 0-3 negative, casing positive DBS parameters and maintained to this day. Patient data were collected from electronic medical records preceded by obtaining an informed consent for research and publication purposes. Stimulation parameter adjustments were confirmed with the digital records of the local device provider (Medtronic).
PSJ is a connectivity confluence point of white matter pathways in the posterior quadrant of the hemispheres. White mater DBS could be considered for research as a potential complementary target for neuromodulation of refractory epilepsy.
本报告旨在描述在17年的随访期间，左侧海马电极迁移至后颞叶沟回（PSJ）的患者中神经调节对癫痫控制的影响。
我们报告一例耐药性癫痫女性患者，其癫痫始于7岁，接受了基于立体定向框架的左侧海马电极植入术以进行深部脑刺激（DBS）。术后1个月的磁共振成像显示电极在PSJ处发生向后迁移。采用2伏-120微秒-145赫兹、触点0-3负极、外壳正极的DBS参数可使癫痫发作持续减少（Engel IC级），且这种效果一直维持至今。患者数据从电子病历中收集，收集前已获得用于研究和发表目的的知情同意书。刺激参数调整通过当地设备供应商（美敦力公司）的数字记录得以确认。
PSJ是半球后象限白质通路的连接汇合点。白质DBS可作为难治性癫痫神经调节的潜在补充靶点进行研究。
