单侧慢性海马电刺激治疗颞叶癫疒间的疗效观察

Therapeutic efficacy of chronic unilateral hippocampus electric stimulation for temporal lobe epilepsy

目的初步探讨单侧慢性海马电刺激治疗颞叶癫疒间的疗效。方法选取经过术前评估认为不适宜行前颞叶切除术的5例颞叶癫疒间病人。癫疒间灶均位于左侧颞叶,其中3例致疒间灶对侧颞叶存在结构性病损,1例对侧颞叶存在功能性异常,1例颞叶病灶累及优势半球侧语言功能区。进一步定位评估单侧颞叶致疒间灶起源,立体定向下向致疒间侧海马头部植入刺激电极,术后进行慢性电刺激,观察控制癫疒间发作的效果及不良反应。结果刺激器埋植术后及慢性电刺激开启后未见明显不良反应。术后随访14～24个月,发作次数平均减少〉75%1例,〉50%3例,无明显改善1例。结论对于部分不适合进行前颞叶切除手术的难治性颞叶癫疒间病人,慢性海马电刺激是一项可供选择的治疗方法。

Objective To investigate the effectiveness and safety of unilateral chronic hippocampus electric stimulation for temporal lobe epilepsy. Methods Five patients with temporal lobe epilepsy who were not suitable for anterior temporal lobectomy were selected. The epileptogenic zones were localized in the left temporal lobe in all the patients including 3 patients with structural lesions on the contralateral temporal lobe, 1 functional abnormality on the contralateral temporal lobe and 1 temporal lobe lesion involving language area of dominant hemispheric side. Unilateral temporal lobe seizure origin were identified by further localizing evaluation.Medtronic electrodes were implanted into the hippocampal head of epileptogenic focus side under stereotactic surgery. The chronic electric stimulation was performed after surgery. The efficacy of controlling the seizure and adverse reaction were observed. Results There was no obvious side effect after implant surgery and the chronic stimulation. During the follow-up period of 14 to 24 months, 1patient had a seizure reduction more than 75%, 3 had a seizure reduction more than 50% and 1 did not have obvious improvement.Conclusion Chronic unilateral hippocampus electric stimulation is a safe treatment for the patients who are not suitable for anterior temporal lobectomy.