头皮脑电图在迷走神经电刺激治疗难治性癫痫研究中的应用

Application of scalp electroencephalogram in treatment of refractory epilepsy with vagus nerve stimulation

癫痫发作是由于大脑神经元过度放电的扩散而引起的,因此半个世纪以来脑电图(EEG)一直是科学家研究癫痫以及评估癫痫治疗的重要工具。本文综述了近30年头皮EEG在迷走神经电刺激(VNS)治疗难治性癫痫的临床研究中的应用,重点从基于EEG特征预测VNS对药物难治性癫痫的疗效和VNS治疗对药物难治性癫痫患者的EEG影响两方面展开介绍,并阐述相关VNS治疗机制。其中,针对基于EEG特征预测VNS疗效方面,介绍了痫样放电变化、慢皮质电位变化极性、脑电对称性以及脑电功率谱变化等特征指标与疗效的关系;针对VNS治疗对患者EEG特征的影响方面,介绍了VNS治疗后痫样放电、功率谱、同步性、脑网络以及事件相关电位P300振幅的变化等影响。尽管目前的研究尚未确定具有代表性的、可用于临床推广的EEG标志物,本综述可为大宗案例的前瞻性研究奠定基础,有利于指导EEG应用于VNS的临床治疗,为预测、评估VNS疗效以及理解VNS治疗机制提供思路,具有重要的临床价值和科学意义。

Electroencephalogram(EEG)has been an important tool for scientists to study epilepsy and evaluate the treatment of epilepsy for half a century,since epilepsy seizures are caused by the diffusion of excessive discharge of brain neurons.This paper reviews the clinical application of scalp EEG in the treatment of intractable epilepsy with vagus nerve stimulation(VNS)in the past 30 years.It mainly introduces the prediction of the therapeutic effect of VNS on intractable epilepsy based on EEG characteristics and the effect of VNS on EEG of patients with intractable epilepsy,and expounds some therapeutic mechanisms of VNS.For predicting the efficacy of VNS based on EEG characteristics,EEG characteristics such as epileptiform discharge,polarity of slow cortical potential changes,changes of EEG symmetry level and changes of EEG power spectrum are described.In view of the influence of VNS treatment on patients’EEG characteristics,the change of epileptiform discharge,power spectrum,synchrony,brain network and amplitude of event-related potential P300 are described.Although no representative EEG markers have been identified for clinical promotion,this review paves the way for prospective studies of larger patient populations in the future to better apply EEG to the clinical treatment of VNS,and provides ideas for predicting VNS efficacy,assessing VNS efficacy,and understanding VNS treatment mechanisms,with broad medical and scientific implications.