Neuromodulation in epilepsy: state-of-the-art approved therapies

推荐理由

从神经调控的角度探讨了癫痫的治疗和未来的神经调控的发展方向。

文章简介
期刊	Lancet Neurology
发表年份	2021
DOI	10.1016/S1474-4422(21)00300-8
类型	综述
领域	癫痫
引用量	132

推荐信息
推荐人	胡迎炳
审核	郝老师
推荐小组	癫痫小组

摘要

Three neuromodulation therapies have been appropriately tested and approved in refractory focal e pile ps ie s: vagus nerve stimulation (VNS), deep brain stimulation of the anterior nucleus of the thalamus (ANT-D BS), and closed-loop responsive neurostimulation of the epileptogenic zone or zones. These therapies are primarily palliative. Only a few individuals have achieved complete freedom from seizures for more than 12 months with these therapies, whereas more than half have benefited from long-term reduction in seizure frequency of more than 50%. Implantation -related adverse events primarily include infection and pain at the implant site. Intracranial haemorrhage is a frequent adverse event for ANT-D BS and responsive neurostimulation. Other stimulation-specific side -effects are observed with VNS and ANT-DBS. Biomarkers to predict response to neuromodulation therapies are not available, and high-level evidence to aid decision making about when and for whom these therapies should be preferred over other antiepileptic treatments is scant. Future studies are thus needed to address these shortfalls in knowledge, approve other forms of neuromodulation, and develop personalised closed -loop therapies with embedded machine learning. Until then, neuromodulation could be considered for individuals with intractable seizures, ideally after the possibility of curative surgical treatment has been carefully assessed and ruled out or judged less appropriate.

细分领域

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