医学
癫痫
抗药性癫痫
神经刺激
Lennox-Gastaut综合征
皮质发育不良
神经调节
癫痫外科
耐火材料(行星科学)
脑深部刺激
难治性癫痫
儿科
生活质量(医疗保健)
麻醉
内科学
刺激
精神科
帕金森病
疾病
物理
护理部
天体生物学
作者
Deepankar Mohanty,Kimberly Houck,Cristina Trandafir,Zulfi Haneef,Cemal Karakas,Steven Lee,Daniel J. Curry,James J. Riviello,Irfan Ali
出处
期刊:Journal of neurosurgery
[Journal of Neurosurgery Publishing Group]
日期:2024-04-01
卷期号:: 1-9
标识
DOI:10.3171/2024.2.peds23531
摘要
OBJECTIVE Responsive neurostimulation (RNS) is a US FDA-approved form of neuromodulation to treat patients with focal-onset drug-resistant epilepsy (DRE) who are ineligible for or whose condition is refractory to resection. However, the FDA approval only extends to use in patients with one or two epileptogenic foci. Recent literature has shown possible efficacy of thalamic RNS in patients with Lennox-Gastaut syndrome and multifocal epilepsy. The authors hypothesized that RNS of thalamic nuclei may be effective in seizure reduction for patients with multifocal or regionalized-onset DRE. METHODS The authors performed a retrospective chart review of all patients who had an RNS device managed at Texas Children’s Hospital between July 2016 and September 2023, with at least one active electrode in the thalamic nuclei and ≥ 12 months of postimplantation follow-up. Information conveyed by the patient or their caregiver provided data on the change in the clinical seizure frequency, quality of life (QOL), and seizure severity between the preimplantation baseline visit and the last office visit (LOV). RESULTS Thirteen patients (ages 8–24 years) were identified with active RNS leads in thalamic nuclei (11 centromedian and 2 anterior nucleus). At LOV, 46% of patients reported 50%–100% clinical seizure reduction (classified as responders), 15% reported 25%–49% reduction, and 38% reported < 25% reduction or no change. Additionally, 42% of patients reported subjective improvement in QOL and 58% reported improved seizure severity. Patients with focal cortical dysplasia (FCD) responded strongly: 3 of 5 (60%) reported ≥ 80% reduction in seizure burden and improvement in seizure severity and QOL. Patients with multifocal epilepsy and bilateral thalamocortical leads also did well, with all 3 reporting ≥ 50% reduction in seizures. CONCLUSIONS RNS of thalamic nuclei shows promising results in reducing seizure burden for patients with multifocal or regional-onset DRE, particularly in a bilateral thalamocortical configuration or when addressing an underlying FCD.
科研通智能强力驱动
Strongly Powered by AbleSci AI