丘脑前核电刺激术治疗难治性部分性癫痫的手术方法及疗效分析

Surgical techniques and therapeutic effect of deep brain stimulation of anterior nucleus thalamus for refractory partial epilepsy

目的探讨丘脑前核电刺激治疗难治性部分性癫痫的手术方法及术后疗效。方法回顾性纳入首都医科大学附属北京天坛医院神经外科2015年3月至2016年11月收治的8例难治性部分性癫痫患者。8例患者均不适合行切除性手术，全部行丘脑前核电刺激术。分析8例患者的临床资料和术后随访结果；评价术前、术后癫痫发作的次数，癫痫的严重程度，生命质量，抑郁，焦虑状态等指标。结果8例难治性部分性癫痫患者平均随访（18．0±2．4）个月。术后每月的发作次数明显减少[术前为（36．4±13．4）次、术后为（13．9±6．2）次，P=0．012]，其缓解率为（54．3±7．4）％。术后癫痫发作的严重程度明显改善[利物浦癫痫严重程度评分术前为（38．4±5．3）分、术后为（22．3±4．9）分，P=0．001]，缓解率为（46．0±8．4）％；患者的生命质量明显提高[生命质量89项评分术前为（71．2±2．7）分、术后为（80．0±2．9）分，P=0．001]，改善率为（12．6±2．3）％。结论对不具备切除性手术指征的难治性部分性癫痫患者，丘脑前核电刺激具有一定的治疗作用，有必要进行进一步的临床研究。

Objective To discuss the surgical techniques and therapeutic effect of deep brain stimulation of anterior nucleus thalamus for refractory partial epilepsy. Methods Eight drug-resistant partial epilepsy patients, with no indication of respective surgery, were treated at Neurosnrgery Department of Beijing Tiantan Hospital, Capital Medical University from March 2015 to November 2016 and retrospectively enrolled into this study. The seizure frequency, severity of seizure, quality of life, depression and anxiety status and other clinical outcome features in pre-surgical and post-surgical periods were analyzed. Results Eight patients with refractory partial epilepsy were followed up for 18.0 ± 2.4 months. The seizure frequency post surgery was significantly reduced （36. 4 ± 13.4 times per month prior to operation, 13.9 ± 6. 2 times per month post operation, P =0. 012） and the remission rate was 54. 3% ± 7.4%. The severity of seizure was improved based on the Liverpool seizure severity scale （38.4 ± 5.3 points prior to operation, 22. 3 ± 4.9 points post operation, P = 0. 001 ） and the remission rate was 46. 0% ± 8.4%. The quality of life was significantly improved based on the Quality of Life in Epilepsy Inventory-89 （71.2 ± 2.7 points prior to operation, 80.0±2.9 points post operation, P=0.001） and the improvement rate was 12.6% ± 2.3%. Conclusion For patients with refractory partial epilepsy without indication of respective surgery, deep brain stimulation of anterior nucleus thalamus might have certain treatment effect, which still needs further clinical research.