Srinivasan Subhiksha, Suresh Surya, Chaitanya Ganne, Saranathan Manoj, Tandon Nitin, Pati Sandipan
Texas Institute of Restorative Neurotechnologies, Department of Neurology, The University of Texas Health Science Center at Houston, TX, USA.
Department of Radiology, University of Massachusetts Chan Medical School, Boston, USA.
Epilepsy Behav Rep. 2025 Feb 17;30:100755. doi: 10.1016/j.ebr.2025.100755. eCollection 2025 Jun.
This case series reports the formidable challenge posed by postencephalitic epilepsies, characterized by frequent drug-resistant seizures and neuropsychiatric and cognitive comorbidities. Polypharmacy is frequently required, and surgical resection may not be feasible due to multifocality. Neuromodulation therapies, including Deep Brain Stimulation (DBS) and Responsive Neurostimulation (RNS), offer a potential lifeline. In this case series, we shed light on the intricate landscape of seizure management and neuropsychiatric comorbidities in five individuals with frequent seizures (often weekly) and ultra-refractory epilepsy (defined as resistance to more than six different antiseizure medications, including failed epilepsy surgery) following catastrophic encephalitis. Four out of five patients achieved at least 50% reduction in seizure frequency following multimodal neuromodulation interventions. Moreover, we underscore the pivotal role of RNS electrocorticography (ECoG) in monitoring the epileptiform burden to guide therapy. Postencephalitic patients often present with a complex interplay of epileptic and nonepileptic (including neuropsychiatric) events, necessitating distinct therapeutic approaches. RNS ECoG emerges as a critical tool for differentiation and tailored therapy. While our findings highlight the potential effectiveness of neuromodulation in managing postencephalitic epilepsy, further research is needed to identify predictors of treatment response and explore the application of these therapies in chronic epilepsy caused by encephalitis. Overall, neuromodulation offers hope for improving these patients' quality of life.
本病例系列报告了脑炎后癫痫所带来的巨大挑战，其特点是频繁出现耐药性癫痫发作以及神经精神和认知共病。通常需要联合使用多种药物，由于病灶多灶性，手术切除可能不可行。神经调节疗法，包括深部脑刺激（DBS）和反应性神经刺激（RNS），提供了一条潜在的生命线。在本病例系列中，我们揭示了五例频繁发作（通常每周发作）且患有超难治性癫痫（定义为对六种以上不同的抗癫痫药物耐药，包括癫痫手术失败）的灾难性脑炎患者癫痫管理和神经精神共病的复杂情况。五名患者中有四名在多模式神经调节干预后癫痫发作频率至少降低了50%。此外，我们强调了RNS皮层脑电图（ECoG）在监测癫痫样负荷以指导治疗方面的关键作用。脑炎后患者常表现出癫痫和非癫痫（包括神经精神）事件的复杂相互作用，需要不同的治疗方法。RNS ECoG成为鉴别和个性化治疗的关键工具。虽然我们的研究结果突出了神经调节在治疗脑炎后癫痫方面的潜在有效性，但仍需要进一步研究以确定治疗反应的预测因素，并探索这些疗法在脑炎所致慢性癫痫中的应用。总体而言，神经调节为改善这些患者的生活质量带来了希望。
