Kimata Anna R, Collins Scott A, Asaad Wael F, Ayub Neishay
Department of Neuroscience, Brown University, Providence, Rhode Island.
The Warren Alpert Medical School of Brown University, Providence, Rhode Island.
J Neurosurg Case Lessons. 2024 Oct 7;8(15). doi: 10.3171/CASE24369.
Responsive neurostimulation (RNS) has emerged as an effective neuromodulatory intervention for patients with medically refractory epilepsy who are not candidates for resective or ablative surgery. However, in patients with multifocal seizures arising from a widely distributed network, optimizing lead placement can be challenging.
Here, the authors present the case of a patient with drug-resistant multifocal, nonlateralizing seizures and multiple developmental brain lesions who underwent phase II monitoring with stereoelectroencephalography electrodes targeting the lesion and surrounding cortex as well as the centromedian thalamus. Neurophysiological signals observed during recorded events implicated a seizure network within the left perisylvian polymicrogyria, involving the left parietal operculum, insula, and centromedian thalamic regions rather than a single focus.
Using a regional RNS approach to modulate this network, the patient improved from 5 seizures a day to freedom from disabling seizures shortly after lead implantation despite low stimulation parameters. This has implications for understanding the timescale of adaptive mechanisms that occur in response to stimulation and supports the use of RNS as a surgical treatment for drug-resistant epilepsy. https://thejns.org/doi/10.3171/CASE24369.
响应性神经刺激（RNS）已成为一种有效的神经调节干预措施，适用于那些不适合进行切除性或消融性手术的药物难治性癫痫患者。然而，对于源自广泛分布网络的多灶性癫痫发作患者，优化电极放置可能具有挑战性。
在此，作者介绍了一名患有耐药性多灶性、非定位性癫痫发作且有多处发育性脑病变的患者的病例，该患者接受了二期监测，使用立体脑电图电极靶向病变及其周围皮层以及丘脑中央中核。在记录事件期间观察到的神经生理信号表明，癫痫发作网络位于左侧外侧裂周多小脑回内，涉及左侧顶叶岛盖、岛叶和丘脑中央中核区域，而非单一病灶。
采用区域RNS方法调节该网络，尽管刺激参数较低，但患者在电极植入后不久即从每日5次癫痫发作改善为无致残性癫痫发作。这对于理解响应刺激时发生的适应性机制的时间尺度具有启示意义，并支持将RNS用作药物难治性癫痫的手术治疗方法。https://thejns.org/doi/10.3171/CASE24369。
