Brabant Paige J, Beaudreault Cameron P, Wolf Steven M, McGoldrick Patricia E, Ghatan Saadi, Muh Carrie R
New York Medical College, Valhalla, New York.
Department of Pediatric Neurology, Boston Children's Health Physicians, Hawthorne, New York.
J Neurosurg Case Lessons. 2024 Oct 7;8(15). doi: 10.3171/CASE23411.
Responsive neurostimulation (RNS) is often considered to be a palliative therapy for drug-resistant epilepsy (DRE) and is generally not considered to be a treatment for patients with tuberous sclerosis complex (TSC). Here, the authors present the case of a 24-year-old male with TSC who obtained seizure freedom following RNS device implantation.
Prior to RNS device implantation, the patient underwent tuberectomies, subependymal giant cell astrocytoma resection, vagus nerve stimulator placement, and left frontal lobe resection but continued to have frequent seizures. An RNS device was implanted, which initially led to a decrease in seizures, but he continued to have 12 seizures per month. He then underwent lead revision for stimulation via a different electrode. After that lead change, he had no seizures for almost 3 years. In the following 3 years, he had two episodes of breakthrough seizures, both of which occurred with medication weans. Although the patient still requires antiseizure medication, he has had years of seizure freedom with RNS therapy.
This study exhibits the potential effectiveness of RNS therapy for patients with TSC and DRE. RNS should be considered for patients with TSC when other therapies have not sufficiently treated their epilepsy. https://thejns.org/doi/10.3171/CASE23411.
反应性神经刺激（RNS）通常被认为是一种针对药物难治性癫痫（DRE）的姑息治疗方法，一般不被视为结节性硬化症（TSC）患者的治疗手段。在此，作者介绍了一例24岁患有TSC的男性患者，在植入RNS设备后实现了无癫痫发作。
在植入RNS设备之前，该患者接受了结节切除术、室管膜下巨细胞星形细胞瘤切除术、迷走神经刺激器置入术和左额叶切除术，但仍频繁发作癫痫。植入了RNS设备，最初癫痫发作有所减少，但他每月仍有12次发作。随后他接受了通过不同电极进行刺激的电极修正术。在那次电极更换后，他近3年没有癫痫发作。在接下来的3年里，他有两次突破性癫痫发作，均在减药时发生。尽管该患者仍需要抗癫痫药物治疗，但通过RNS治疗他已多年无癫痫发作。
本研究展示了RNS治疗对TSC和DRE患者的潜在有效性。当其他疗法未能充分治疗癫痫时，TSC患者应考虑采用RNS治疗。https://thejns.org/doi/10.3171/CASE23411 。
