Deep brain stimulation of the anterior nucleus of the thalamus for drug-resistant epilepsy

Springer Science and Business Media LLC - Tập 42 - Trang 287-296 - 2018
Yasin Temel1,2,3, Louis Wagner4, Olaf E. M. G. Schijns1,5,3, Rob Rouhl6,1,2,4, Tim A. M. Bouwens van der Vlis3, Govert Hoogland1,2,3, Pieter Kubben3, Frédéric L. W. V. J. Schaper1,4, Linda Ackermans3
1School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands
2European Graduate School of Neuroscience (Euron), Maastricht University, Maastricht, The Netherlands
3Department of Neurosurgery, Academic Center for Epileptology (ACE), Maastricht University Medical Center, Maastricht (MUMC), Maastricht, The Netherlands
4Department of Neurology, Academic Center for Epileptology (ACE), Kempenhaeghe, MUMC, Maastricht, The Netherlands
5European Graduate School of Neuroscience (EURON), Maastricht University, Maastricht, The Netherlands
6Academic Center for Epileptology MUMC+ and Kempenhaeghe, Maastricht, The Netherlands

Tóm tắt

Despite the use of first-choice anti-epileptic drugs and satisfactory seizure outcome rates after resective epilepsy surgery, a considerable percentage of patients do not become seizure free. ANT-DBS may provide for an alternative treatment option in these patients. This literature review discusses the rationale, mechanism of action, clinical efficacy, safety, and tolerability of ANT-DBS in drug-resistant epilepsy patients. A review using systematic methods of the available literature was performed using relevant databases including Medline, Embase, and the Cochrane Library pertaining to the different aspects ANT-DBS. ANT-DBS for drug-resistant epilepsy is a safe, effective and well-tolerated therapy, where a special emphasis must be given to monitoring and neuropsychological assessment of both depression and memory function. Three patterns of seizure control by ANT-DBS are recognized, of which a delayed stimulation effect may account for an improved long-term response rate. ANT-DBS remotely modulates neuronal network excitability through overriding pathological electrical activity, decrease neuronal cell loss, through immune response inhibition or modulation of neuronal energy metabolism. ANT-DBS is an efficacious treatment modality, even when curative procedures or lesser invasive neuromodulative techniques failed. When compared to VNS, ANT-DBS shows slightly superior treatment response, which urges for direct comparative trials. Based on the available evidence ANT-DBS and VNS therapies are currently both superior compared to non-invasive neuromodulation techniques such as t-VNS and rTMS. Additional in-vivo research is necessary in order to gain more insight into the mechanism of action of ANT-DBS in localization-related epilepsy which will allow for treatment optimization. Randomized clinical studies in search of the optimal target in well-defined epilepsy patient populations, will ultimately allow for optimal patient stratification when applying DBS for drug-resistant patients with epilepsy.

Tài liệu tham khảo

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