文摘
摘要目的:评估病人进行脑深部电刺激(DBS)或响应神经刺激迷走神经刺激(VNS)后(RNS)。
背景:在许多耐药患者癫痫(DRE),神经调节与迷走神经刺激法,DBS, RNS减少发作频率但很少产生癫痫自由[1 - 4]。尽管神经调节的使用增多,双重神经刺激已收到有限的关注[5]。因此,目前尚不清楚,如果有不同的疗效和安全性,或者临床因素存在,可能会允许一个个性化的治疗方案。
设计/方法:我们回顾了梅奥诊所的病人VNS数据库在佛罗里达州,DBS, RNS装置植入(1/1/2011-9/30/2021)。回顾从工业数据库补充神经的位置。迷走神经刺激法在治疗之前的患病率与星展银行记录和/或RNS神经调节dual-device神经刺激(VNS-DBS或VNS-RNS)。我们比较临床特征和扣押VNS-DBS和VNS-RNS响应能力。
结果:29病人RNS 6之前迷走神经刺激法。所有8个病人DBS曾经历了VNS(6前丘脑;2 centromedian丘脑)。两个VNS-RNS患者接受移植相比,使用VNS-DBS没有。VNS-DBS患者失败更多的抗癫痫药物试验(11.9 vs 6.2, p = 0.020)。VNS-RNS病人有更多的局部癫痫灶(p < 0.001),更有可能发生了入侵脑电图监测(p < 0.001),更有可能有宠物或SPECT成像(p < 0.001)。VNS-DBS患者更有利的前应对迷走神经刺激法(p = 0.025),手脚和4/4病人也看到DBS后改善。一个VNS-DBS移植病人DBS在15个月由于再生铅从脑膜炎感染;没有其他不良事件记录。
结论:VNS-RNS导致更广泛的测试包括脑电图研究。VNS-DBS患者更容易展示初始响应手脚。前瞻性多中心研究需要验证与polyneurostimulation神经刺激相结合,推进决策的差异。
披露:弗洛伊德博士已经收到个人薪酬在500 - 4999美元的范围为在科学咨询服务或数据安全监测委员会诺华。弗洛伊德博士已经收到个人薪酬在500 - 4999美元的范围在艾尔建的演讲人。加西亚博士没有披露。Feyissa博士没有披露。Ritaccio博士的机构收到NIH的研究支持。Ritaccio博士收到发现或技术知识产权利益有关卫生保健。Sirven博士已经收到Neurelis的个人作为一个雇员补偿。Sirven博士已经收到个人薪酬在5000 - 9999美元的范围作为顾问的联合。Sirven博士已经收到个人薪酬在5000 - 9999美元的范围为美敦力公司担任顾问。Sirven博士已经收到个人薪酬在5000 - 9999美元的范围为Neurelis担任顾问。 Dr. Sirven has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sci K. Dr. Sirven has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Medtronic. Dr. Sirven has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for AAN. Dr. Sirven has received stock or an ownership interest from Doximity. Dr. Sirven has received publishing royalties from a publication relating to health care. Erik Middlebrooks has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Varian Medical Systems Inc. Erik Middlebrooks has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Boston Scientific Corp. The institution of Erik Middlebrooks has received research support from Varian Medical Systems Inc. Sanjeet S. Grewal, MD has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Medtronic. Dr. Tatum has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Bioserenity. Dr. Tatum has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Elsevier. Dr. Tatum has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Defense Law Firm on behalf of a patient with epilepsy with funds donated to the Epilepsy Foundation of America. The institution of Dr. Tatum has received research support from Esai. The institution of Dr. Tatum has received research support from Mayo Clinic. The institution of Dr. Tatum has received research support from Liva Nova. The institution of Dr. Tatum has received research support from Engage Pharmaceuticals. The institution of Dr. Tatum has received research support from Xenon. Dr. Tatum has received publishing royalties from a publication relating to health care. Dr. Tatum has received publishing royalties from a publication relating to health care.
