Acerbo Emma, Jegou Aude, Lagarde Stanislas, Pizzo Francesca, Makhalova Julia, Trébuchon Agnès, Bénar Christian-George, Bartolomei Fabrice, Carron Romain
Aix Marseille Université, INSERM, Institut de Neurosciences des Systèmes, Marseille, France.
Epileptology Department, Timone Hospital, Assistance Publique Hôpitaux de Marseille (AP-HM), Marseille, France.
Epilepsia. 2025 Aug;66(8):2690-2702. doi: 10.1111/epi.18405. Epub 2025 Apr 19.
OBJECTIVE: Deep brain stimulation (DBS) is emerging as a promising therapy for patients with drug-resistant epilepsy, particularly those who are either unsuitable for or unresponsive to resective surgery. The potential benefit of DBS in these patients may stem from its ability to reduce excessive brain functional connectivity (FC). Given that patients undergoing presurgical evaluation in our institution are implanted with stereoelectroencephalographic (SEEG) electrodes in the thalamus, specifically in the pulvinar medialis (PuM), our aim was to investigate the impact of different stimulation frequencies on brain FC. We sought to determine whether specific frequencies were more effective in modulating FC. METHODS: SEEG was used to investigate the effects of PuM stimulation across a broad frequency range (1-200 Hz) in a cohort of 14 patients with drug-resistant focal epilepsy. FC was assessed using the nonlinear correlation coefficient (h) and node strength calculations. RESULTS: Our findings revealed a reduction in FC at stimulation frequencies of 10 Hz and >90 Hz, contrasting with an increase in FC in the 20-80-Hz range. This modulation of FC extended beyond the epileptogenic zone, influencing all assessed brain lobes, with the parietal, insular, and subcortical regions particularly affected by high-frequency stimulation. Within the epileptogenic zone, however, the observed FC changes were notably more complex. SIGNIFICANCE: These results underscore the potential of high-frequency stimulation to decrease interictal FC in epilepsy patients, although intermediate frequencies may exacerbate it and warrant caution. Crucially, this study highlights the effects of PuM stimulation on FC patterns, supporting the role of high-frequency thalamic stimulation as a promising DBS parameter for improving epilepsy management strategies.
目的:对于耐药性癫痫患者,尤其是那些不适合进行切除性手术或对切除性手术无反应的患者,脑深部电刺激(DBS)正成为一种有前景的治疗方法。DBS对这些患者的潜在益处可能源于其减少大脑过度功能连接(FC)的能力。鉴于在我们机构接受术前评估的患者在丘脑,特别是内侧丘脑枕(PuM)植入了立体定向脑电图(SEEG)电极,我们的目的是研究不同刺激频率对脑FC的影响。我们试图确定特定频率是否在调节FC方面更有效。 方法:使用SEEG研究了14例耐药性局灶性癫痫患者在较宽频率范围(1 - 200 Hz)内PuM刺激的效果。使用非线性相关系数(h)和节点强度计算来评估FC。 结果:我们的研究结果显示,在10 Hz和>90 Hz的刺激频率下FC降低,而在20 - 80 Hz范围内FC增加。这种FC的调节超出了致痫区,影响了所有评估的脑叶,顶叶、岛叶和皮质下区域尤其受到高频刺激的影响。然而,在致痫区内,观察到的FC变化明显更复杂。 意义:这些结果强调了高频刺激降低癫痫患者发作间期FC的潜力,尽管中频可能会加剧这种情况,需要谨慎。至关重要的是,这项研究突出了PuM刺激对FC模式的影响,支持高频丘脑刺激作为改善癫痫管理策略的一种有前景的DBS参数的作用。
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