个体化脑刺激:神经调控治疗难治性癫痫的新方向

Individualized brain stimulation strategy:A new perspective of neuromodulation for refractory epilepsy

脑刺激是目前治疗难治性癫痫的重要手段,也是极具发展前景的一种神经调控方式。目前临床常用的脑刺激包括丘脑前核深部电刺激和反应性神经刺激。然而,其他刺激方法,包括丘脑底核、丘脑中央中核、海马-杏仁核等靶点的脑深部刺激,不同形式的闭环神经刺激以及慢性阈下皮层刺激等脑刺激方式也展示出良好的临床疗效和应用前景,非常值得深入研究,转化为有效的临床治疗手段。深入揭示不同形式脑刺激的调控作用机制,有针对性的选择合适的癫痫病例,选取适宜的刺激靶点及最优的刺激模式,是提高脑刺激治疗难治性癫痫临床疗效的有效途径,也是进一步研究的方向。

Brain stimulation is not only an important means for the treatment of drug resistant epilepsy,but also the most promising way of neuromodulation.At present,only deep brain stimulation of anterior nucleus of thalamus and responsive neural stimulationare commonly used in clinic.However,some other stimulation methods such as deep brain stimulation including subthalamic nucleus,centromedian thalamic nucleus,hippocampus-amygdala and other targets,together with different forms of closed-loop neuromodulation and chronic subthreshold cortical stimulation also show good clinical efficacy and application prospects.These stimulation methods are worthy of in-depth study and are necessary to be transformed into effective clinical treatment as soon as possible.To deeply reveal the mechanism of different stimulation regulation is the premise of the selection of appropriate candidate,appropriate stimulation targets and optimal stimulation mode in patients with refractory epilepsy.It is also an effective way to improve the clinical efficacy of brain stimulation in the treatment of refractory epilepsy.Additionally,these aspects are also the direction of further research.