深部脑刺激治疗药物难治性癫痫的研究现状_Journal of Epilepsy

Authors：

付孟 ,  张锦凤

包头市中心医院神经内科（包头 014040）;

Corresponding author：

张锦凤, Email: 821504491@qq.com

Keywords：

深部脑刺激; 药物难治性癫痫; 靶点; 副作用

DOI：

10.7507/2096-0247.202210007

Video：

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癫痫是一种短暂性脑神经异常放电引起人体机能出现异常的一种疾病，该疾病目前已然波及全球5 000万余人，人们通常使用药物控制发作，尽管引入了各种新型抗癫痫发作药物（Anti-seizure medications，ASMs），仍有约1/3的患者无法通过ASMs正规治疗得到有效控制，进而发展为药物难治性癫痫（Drug-resistant epilepsy，DRE），持续的癫痫发作会对患者的身体、心理、家庭以及社会造成严重的负担。随着神经外科对立体定向技术的逐步深入研究，研究发现深部脑刺激（Deep brain stimulation，DBS）是一种广泛应用于精神和神经疾病的有效治疗手段，目前，DBS在治疗帕金森病（Parkinson’s disease，PD）方面已取得良好成效，同时该技术的可调节性、可逆性及良好的安全性促使人们通过DBS对精神神经系统疾病进行更深入的研究。目前世界各地已有一定数量的患有不同精神障碍或神经障碍的患者接受DBS治疗，其运用于DRE也得到了良好疗效，本文就DBS的神经调控机制、相关靶点、副作用及研究现状作如下概述，以期对DRE的治疗提供治疗新思路。

Citation： 付孟, 张锦凤. 深部脑刺激治疗药物难治性癫痫的研究现状. Journal of Epilepsy, 2023, 9(2): 147-150. doi: 10.7507/2096-0247.202210007 Copy

1.	葛燕, 刘崇, 孟凡刚, 等. 脑深部电刺激在癫痫治疗中的应用进展. 中华医学杂志, 2013, 4(7): 558-559.
2.	Giuseppina D, Maria G, Teresa S, et al. A systems biology approach for personalized medicine in refractory epilepsy. International Journal of Molecular Sciences, 2019, 20(15): 3717-3717.
3.	Song L, Liu F, Liu Y, et al. Clonazepam add-on therapy for refractory epilepsy in adults and children. Cochrane Database Syst Rev, 2018, 5(5): CD012253.
4.	Taylor RS, Sander JW, Taylor RJ, et al. Predictors of health-related quality of life and costs in adults with epilepsy: a systematic review. Epilepsia, 2011, 52(12): 2168-2180.
5.	Tellez Z, Hernandez R, Moien-Afshari F, et al. Surgical outcomes in lesional and non-lesional epilepsy: a systematic review and meta-analysis. Epilepsy Res, 2010, 89(2-3): 310-318.
6.	Halpern CH, Attiah MA, Tekriwal A, et al. A step-wise approach to deep brain stimulation in mice. Acta Neurochir (Wien), 2014, 156(8): 1515-21.
7.	Lozano AM, Lipsman N, Bergman H, et al. Deep brain stimulation: current challenges and future directions. Nat Rev Neurol, 2019, 15(3): 148-160.
8.	孟凡刚, 陈玲, 刘钰晔, 等. 中国帕金森病脑深部电刺激疗法专家共识(第二版)解读. 中华神经外科杂志, 2021, 37(5): 439-442.
9.	梁国标, 陶英群. 功能神经外科精准时代的助推器-ROSA手术机器人. 中国微侵袭神经外科杂志, 2017, 22(2): 49-50.
10.	Schwalb JM, Hamani C. The history and future of deep brain stimulation. Neurotherapeutics, 2008, 5(1): 3-13.
11.	Horsley V, Clarke RH. The structure and functions of the cerebellum examined by a new method. Brain, 1908, 31: 45-124.
12.	Sobayo T, Mogul DJ. Should stimulation parameters be individualized to stop seizures: Evidence in support of this approach. Epilepsia, 2016, 57(1): 131-140.
13.	Hamani C, Hodaie M, Lozano AM. Present and future of deep brain stimulation for refractory epilepsy. Acta Neurochir (Wien), 2005, 147(3): 227-229.
14.	Mirski MA, Ferrendelli JA. Interruption of the mammillothalamic tract prevents seizures in guinea pigs. Science, 1984, 226(4670): 72-74.
15.	Lega BC, Halpern CH, Jaggi JL, et al. Deep brain stimulation in the treatment of refractory epilepsy: update on current data and future directions. Neurobiol Dis, 2010, 38(3): 354-360.
16.	Wu C, Sharan AD. Neurostimulation for the treatment of epilepsy: a review of current surgical interventions. Neuromodulation, 2013, 16: 10-24.
17.	Mondragon S, Lamarche M. Suppression of motor seizures after specific thalamotomy in chronic epileptic monkeys. Epilepsy Res, 1990, 5(2): 137-145.
18.	刘晓亭, 唐敏, 朱幼玲, 等. 丘脑前核与记忆障碍的研究进展. 中风与神经疾病杂志, 2016, 33(8): 766-768.
19.	Piacentino M, Durisotti C, Garofalo PG, et al. Anterior thalamic nucleus deep brain Stimulation (DBS) for drug-resistant complex partial seizures (CPS) with or without generalization: long-term evaluation and predictive outcome. Acta Neurochir (Wien), 2015, 157(9): 1525-1532.
20.	Kahana MJ, Sekuler R, Caplan JB, et al. Human theta oscillations exhibit task dependence during virtual maze navigation. Nature, 1999, 399(6738): 781-784.
21.	Li MCH, Cook MJ. Deep brain stimulation for drug-resistant epilepsy. Epilepsia, 2018, 59(2): 273-290.
22.	Osorio I, Overman J, Giftakis J, et al. High frequency thalamic stimulation for inoperable mesial temporal epilepsy. Epilepsia, 2007, 48(8): 1561-1571.
23.	Lee KJ, Shon YM, Cho CB. Long-term outcome of anterior thalamic nucleus stimulation for intractable epilepsy. Stereotact Funct Neurosurg, 2012, 90(6): 379-385.
24.	Kerrigan JF, Litt B, Fisher RS, et al. Electrical stimulation of the anterior nucleus of the thalamus for the treatment of intractable epilepsy. Epilepsia, 2004, 45(4): 346-354.
25.	Andrade DM, Zumsteg D, Hamani C, et al. Long-term follow-up of patients with thalamic deep brain stimulation for epilepsy. Neurology, 2006, 66(10): 1571-1573.
26.	Voges BR, Schmitt FC, Hamel W, et al. Deep brain stimulation of anterior nucleus thalami disrupts sleep in epilepsy patients. Epilepsia, 2015, 56(8): e99-e103.
27.	Fisher R, Salanova V, Witt T, et al. Electrical stimulation of the anterior nucleus of thalamus for treatment of refractory epilepsy. Epilepsia, 2010, 51(5): 899-908.
28.	Salanova V, Witt T, Worth R, et al. Long-term efficacy and safety of thalamic stimulation for drug-resistant partial epilepsy. Neurology, 2015, 84(10): 1017-1025.
29.	潘琪, 牛朝诗. 丘脑中央中核-束旁核复合体的解剖生理研究. 中华神经医学杂志, 2006, (08): 859-861.
30.	Yan H, Toyota E, Anderson M, et al. A systematic review of deep brain stimulation for the treatment of drug-resistant epilepsy in childhood. J Neurosurg Pediatr, 2018, 23(3): 274-284.
31.	Parolari L, Schneeberger M, Heintz N, et al. Functional analysis of distinct populations of subthalamic nucleus neurons on Parkinson's disease and OCD-like behaviors in mice. Mol Psychiatry, 2021, 26(11): 7029-7046.
32.	刘智华. 人脑海马结构的断面与MRI解剖. 重庆医科大学, 2012, 硕士学位论文.
33.	Dell KL, Cook MJ, Maturana MI. Deep Brain Stimulation for Epilepsy: Biomarkers for Optimization. Curr Treat Options Neurol, 2019, 21(10): 47.
34.	Vonck K, Sprengers M, Carrette E, et al. A decade of experience with deep brain stimulation for patients with refractory medial temporal lobe epilepsy. Int J Neural Syst, 2013, 23(1): 1250034.
35.	Wang J, Zhang Y, Zhang H, et al. Nucleus accumbens shell: a potential target for drug-resistant epilepsy with neuropsychiatric disorders. Epilepsy Res, 2020, 164: 106365.
36.	Rolston JD, Deng H, Wang DD, et al. Multiple subpial transections for medically refractory epilepsy: a disaggregated review of patient-level data. Neurosurgery, 2018, 82(5): 613-620.
37.	Chang B, Xu J. Deep brain stimulation for refractory temporal lobe epilepsy: a systematic review and meta-analysis with an emphasis on alleviation of seizure frequency outcome. Childs Nerv Syst, 2018, 34(2): 321-327.
38.	Valentín A, Selway RP, Amarouche M, et al. Intracranial stimulation for children with epilepsy. Eur J Paediatr Neurol, 2017, 21(1): 223-231.
39.	Torres CV, Iza-Vallejo B, Navas-García M, et al. Estimulación cerebral profunda en la epilepsia farmacorresistente [Deep brain stimulation in drug-resistant epilepsy]. Rev Neurol, 2020, 70(5): 183-192.
40.	Streng ML, Krook-Magnuson E. The cerebellum and epilepsy. Epilepsy Behav, 2021, 121（Pt B）: 106909.
41.	Jitkritsadakul O, Bhidayasiri R, Kalia SK, et al. Systematic review of hardware-related complications of deep brain stimulation: do new indications pose an increased risk? Brain Stimul, 2017, 10（5）: 967-976.

1. 葛燕, 刘崇, 孟凡刚, 等. 脑深部电刺激在癫痫治疗中的应用进展. 中华医学杂志, 2013, 4(7): 558-559.
2. Giuseppina D, Maria G, Teresa S, et al. A systems biology approach for personalized medicine in refractory epilepsy. International Journal of Molecular Sciences, 2019, 20(15): 3717-3717.
3. Song L, Liu F, Liu Y, et al. Clonazepam add-on therapy for refractory epilepsy in adults and children. Cochrane Database Syst Rev, 2018, 5(5): CD012253.
4. Taylor RS, Sander JW, Taylor RJ, et al. Predictors of health-related quality of life and costs in adults with epilepsy: a systematic review. Epilepsia, 2011, 52(12): 2168-2180.
5. Tellez Z, Hernandez R, Moien-Afshari F, et al. Surgical outcomes in lesional and non-lesional epilepsy: a systematic review and meta-analysis. Epilepsy Res, 2010, 89(2-3): 310-318.
6. Halpern CH, Attiah MA, Tekriwal A, et al. A step-wise approach to deep brain stimulation in mice. Acta Neurochir (Wien), 2014, 156(8): 1515-21.
7. Lozano AM, Lipsman N, Bergman H, et al. Deep brain stimulation: current challenges and future directions. Nat Rev Neurol, 2019, 15(3): 148-160.
8. 孟凡刚, 陈玲, 刘钰晔, 等. 中国帕金森病脑深部电刺激疗法专家共识(第二版)解读. 中华神经外科杂志, 2021, 37(5): 439-442.
9. 梁国标, 陶英群. 功能神经外科精准时代的助推器-ROSA手术机器人. 中国微侵袭神经外科杂志, 2017, 22(2): 49-50.
10. Schwalb JM, Hamani C. The history and future of deep brain stimulation. Neurotherapeutics, 2008, 5(1): 3-13.
11. Horsley V, Clarke RH. The structure and functions of the cerebellum examined by a new method. Brain, 1908, 31: 45-124.
12. Sobayo T, Mogul DJ. Should stimulation parameters be individualized to stop seizures: Evidence in support of this approach. Epilepsia, 2016, 57(1): 131-140.
13. Hamani C, Hodaie M, Lozano AM. Present and future of deep brain stimulation for refractory epilepsy. Acta Neurochir (Wien), 2005, 147(3): 227-229.
14. Mirski MA, Ferrendelli JA. Interruption of the mammillothalamic tract prevents seizures in guinea pigs. Science, 1984, 226(4670): 72-74.
15. Lega BC, Halpern CH, Jaggi JL, et al. Deep brain stimulation in the treatment of refractory epilepsy: update on current data and future directions. Neurobiol Dis, 2010, 38(3): 354-360.
16. Wu C, Sharan AD. Neurostimulation for the treatment of epilepsy: a review of current surgical interventions. Neuromodulation, 2013, 16: 10-24.
17. Mondragon S, Lamarche M. Suppression of motor seizures after specific thalamotomy in chronic epileptic monkeys. Epilepsy Res, 1990, 5(2): 137-145.
18. 刘晓亭, 唐敏, 朱幼玲, 等. 丘脑前核与记忆障碍的研究进展. 中风与神经疾病杂志, 2016, 33(8): 766-768.
19. Piacentino M, Durisotti C, Garofalo PG, et al. Anterior thalamic nucleus deep brain Stimulation (DBS) for drug-resistant complex partial seizures (CPS) with or without generalization: long-term evaluation and predictive outcome. Acta Neurochir (Wien), 2015, 157(9): 1525-1532.
20. Kahana MJ, Sekuler R, Caplan JB, et al. Human theta oscillations exhibit task dependence during virtual maze navigation. Nature, 1999, 399(6738): 781-784.
21. Li MCH, Cook MJ. Deep brain stimulation for drug-resistant epilepsy. Epilepsia, 2018, 59(2): 273-290.
22. Osorio I, Overman J, Giftakis J, et al. High frequency thalamic stimulation for inoperable mesial temporal epilepsy. Epilepsia, 2007, 48(8): 1561-1571.
23. Lee KJ, Shon YM, Cho CB. Long-term outcome of anterior thalamic nucleus stimulation for intractable epilepsy. Stereotact Funct Neurosurg, 2012, 90(6): 379-385.
24. Kerrigan JF, Litt B, Fisher RS, et al. Electrical stimulation of the anterior nucleus of the thalamus for the treatment of intractable epilepsy. Epilepsia, 2004, 45(4): 346-354.
25. Andrade DM, Zumsteg D, Hamani C, et al. Long-term follow-up of patients with thalamic deep brain stimulation for epilepsy. Neurology, 2006, 66(10): 1571-1573.
26. Voges BR, Schmitt FC, Hamel W, et al. Deep brain stimulation of anterior nucleus thalami disrupts sleep in epilepsy patients. Epilepsia, 2015, 56(8): e99-e103.
27. Fisher R, Salanova V, Witt T, et al. Electrical stimulation of the anterior nucleus of thalamus for treatment of refractory epilepsy. Epilepsia, 2010, 51(5): 899-908.
28. Salanova V, Witt T, Worth R, et al. Long-term efficacy and safety of thalamic stimulation for drug-resistant partial epilepsy. Neurology, 2015, 84(10): 1017-1025.
29. 潘琪, 牛朝诗. 丘脑中央中核-束旁核复合体的解剖生理研究. 中华神经医学杂志, 2006, (08): 859-861.
30. Yan H, Toyota E, Anderson M, et al. A systematic review of deep brain stimulation for the treatment of drug-resistant epilepsy in childhood. J Neurosurg Pediatr, 2018, 23(3): 274-284.
31. Parolari L, Schneeberger M, Heintz N, et al. Functional analysis of distinct populations of subthalamic nucleus neurons on Parkinson's disease and OCD-like behaviors in mice. Mol Psychiatry, 2021, 26(11): 7029-7046.
32. 刘智华. 人脑海马结构的断面与MRI解剖. 重庆医科大学, 2012, 硕士学位论文.
33. Dell KL, Cook MJ, Maturana MI. Deep Brain Stimulation for Epilepsy: Biomarkers for Optimization. Curr Treat Options Neurol, 2019, 21(10): 47.
34. Vonck K, Sprengers M, Carrette E, et al. A decade of experience with deep brain stimulation for patients with refractory medial temporal lobe epilepsy. Int J Neural Syst, 2013, 23(1): 1250034.
35. Wang J, Zhang Y, Zhang H, et al. Nucleus accumbens shell: a potential target for drug-resistant epilepsy with neuropsychiatric disorders. Epilepsy Res, 2020, 164: 106365.
36. Rolston JD, Deng H, Wang DD, et al. Multiple subpial transections for medically refractory epilepsy: a disaggregated review of patient-level data. Neurosurgery, 2018, 82(5): 613-620.
37. Chang B, Xu J. Deep brain stimulation for refractory temporal lobe epilepsy: a systematic review and meta-analysis with an emphasis on alleviation of seizure frequency outcome. Childs Nerv Syst, 2018, 34(2): 321-327.
38. Valentín A, Selway RP, Amarouche M, et al. Intracranial stimulation for children with epilepsy. Eur J Paediatr Neurol, 2017, 21(1): 223-231.
39. Torres CV, Iza-Vallejo B, Navas-García M, et al. Estimulación cerebral profunda en la epilepsia farmacorresistente [Deep brain stimulation in drug-resistant epilepsy]. Rev Neurol, 2020, 70(5): 183-192.
40. Streng ML, Krook-Magnuson E. The cerebellum and epilepsy. Epilepsy Behav, 2021, 121（Pt B）: 106909.
41. Jitkritsadakul O, Bhidayasiri R, Kalia SK, et al. Systematic review of hardware-related complications of deep brain stimulation: do new indications pose an increased risk? Brain Stimul, 2017, 10（5）: 967-976.

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