脑深部电刺激治疗药物难治性癫痫:5个不同刺激靶点的长期临床效果比较

Deep brain stimulation for intractable epilepsy:a long-term clinical comparison of five different stimulating targets

目的探讨丘脑前核、丘脑底核、海马、杏仁核及中央中核等5个不同刺激靶点行脑深部电刺激(DBS)术,治疗药物难治性癫痫的长期临床效果。方法对采用丘脑前核、丘脑底核、海马、杏仁核和中央中核等5个不同靶点电刺激术治疗的43例药物难治性癫痫患者进行长期随访,比较患者在DBS术前半年和术后随访时最近半年的癫痫发作频率,并对5个不同刺激靶点的长期临床效果做进一步比较。结果5个刺激靶点行脑深部电刺激治疗药物难治性癫痫均可以有效减少癫痫的发作频率,其中丘脑前核电刺激的20例患者中15例患者的发作改善在50%以上;海马电刺激4例患者中有3例患者的发作改善频率在50%以上;5例丘脑底核电刺激患者的发作频率均减少在50%以上;中央中核电刺激的患者较开机前改善80%以上;杏仁核电刺激的患者最近6个月无发作,发作频率较开机前改善100%。结论药物难治性癫痫使用不同的刺激靶点进行DBS治疗,均可以有效改善患者的癫痫发作频率。

Objective To investigate the long-term clinical outcomes of deep brain stimulation(DBS)on intractable epilepsy with five different stimulating targets:anterior thalamic nucleus,subthalamic nucleus,hippocampus,amygdale and centromedian nucleus.Methods 43 patients with drug-resistant epilepsy were treated with electrical stimulation of the anterior thalamic nucleus,subthalamic nucleus,hippocampus,amygdala and centromedian nucleus.The seizure frequency of patients in the first half of the year before deep brain stimulation operation and in the first half of this follow-up in October 2020 were compared to study the difference of long-term clinical effect of five different stimulating targets.Results 5 stimulating targets all could effectively reduce the seizure frequency of epilepsy.Among them,15/20 patients with subthalamic nuclear stimulation had seizure improvement of more than 50%.3/4 patients with hippocampal electrical stimulation improved the seizure frequency by more than 50%.Five patients with subthalamic nuclear stimulation reduced the seizure frequency by more than 50%.The patients with central and middle nuclear stimulation improved the seizure frequency by more than 80%compared with that before operation.The patients with amygdala nuclear stimulation had no seizure in the last six months,and the seizure frequency improved by 100%compared with that before operaion.Conclusion Different targets of deep brain stimulation can effectively improve the seizure frequency of patients with drug-resistant epilepsy.