Yang Jimmy C, Skelton Henry, Isbaine Faical, Bullinger Katie L, Alwaki Abdulrahman, Cabaniss Brian T, Willie Jon T, Gross Robert E
Department of Neurological Surgery, The Ohio State University College of Medicine, Columbus, Ohio, USA,
Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA,
Stereotact Funct Neurosurg. 2024;102(6):345-355. doi: 10.1159/000540431. Epub 2024 Aug 14.
Neuromodulation is an important treatment modality for patients with drug-resistant epilepsy who are not candidates for resective or ablative procedures. However, randomized controlled trials and real-world studies reveal that a subset of patients will experience minimal reduction or even an increase in seizure frequency after neuromodulation. We describe our experience with patients who undergo a second intracranial neuromodulation procedure after unsatisfactory initial response to intracranial neuromodulation.
We performed a retrospective chart review to identify all patients who had undergone deep brain stimulation (DBS) of the anterior nucleus of the thalamus (ANT) or responsive neurostimulation (RNS), followed by additional intracranial neuromodulatory procedures, with at least 12 months of follow-up. Demographic and clinical data, including seizure frequencies, were collected.
All patients had temporal lobe epilepsy. Six patients were treated with concurrent ANT DBS and temporal lobe RNS, and 3 patients transitioned between neuromodulation systems. Of the patients treated concurrently with ANT DBS and temporal lobe RNS, 5 of the 6 patients experienced additional reduction in seizure frequency after adding a second neuromodulation system. Of the patients who switched between neuromodulation modalities, all patients experienced further reduction in seizure frequency.
For patients who do not experience adequate benefit from initial therapy with ANT DBS or temporal lobe RNS, the addition of a neuromodulation system or switching to a different form of neuromodulation may allow for additional reduction in seizure frequency. Larger studies will need to be performed to understand whether the use of multiple systems concurrently leads to improved clinical results in patients who are initially treatment resistant to neuromodulation.
神经调节是药物难治性癫痫患者的一种重要治疗方式，这些患者不适合进行切除性或消融性手术。然而，随机对照试验和真实世界研究表明，一部分患者在神经调节后癫痫发作频率降低甚微，甚至有所增加。我们描述了颅内神经调节初始反应不佳后接受第二次颅内神经调节手术的患者的情况。
我们进行了一项回顾性病历审查，以确定所有接受丘脑前核（ANT）深部脑刺激（DBS）或反应性神经刺激（RNS），随后进行额外颅内神经调节手术，并至少随访12个月的患者。收集了人口统计学和临床数据，包括癫痫发作频率。
所有患者均患有颞叶癫痫。6例患者同时接受ANT DBS和颞叶RNS治疗，3例患者在神经调节系统之间转换。在同时接受ANT DBS和颞叶RNS治疗的患者中，6例患者中有5例在添加第二个神经调节系统后癫痫发作频率进一步降低。在神经调节方式之间转换的患者中，所有患者的癫痫发作频率均进一步降低。
对于初始接受ANT DBS或颞叶RNS治疗未获得充分益处的患者，添加神经调节系统或转换为不同形式的神经调节可能会进一步降低癫痫发作频率。需要进行更大规模的研究，以了解同时使用多个系统是否会改善最初对神经调节治疗耐药的患者的临床结果。
