CM-Pf deep brain stimulation in polyneuromodulation for epilepsy

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

Epileptic Disorders Pub Date : 2024-07-30 DOI:10.1002/epd2.20255

W. O. Tatum, B. Freund, E. H. Middlebrooks, B. N. Lundstrom, A. M. Feyissa, J. J. Van Gompel, S. S. Grewal

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引用次数: 0

Abstract

Objective

Neuromodulation is a viable option for patients with drug-resistant epilepsies. We reviewed the management of patients with two deep brain neurostimulators. In addition, patients implanted with a device targeting the centromedian-parafascicular (CM-Pf) nuclear complex supplements this report to provide an illustrative case to implantation and programming a patient with three active devices.

Methods

A narrative review using PubMed and Embase identified patients with drug-resistant epilepsy implanted with more than one neurostimulator was performed. Combinations of vagus nerve stimulation (VNS), deep brain stimulation (DBS), and responsive neurostimulation (RNS) were identified. We provide a background of a newly reported case of an adult with a triple implant eventually responding to CM-Pf DBS as the third implant following suboptimal benefit from VNS and RNS.

Results

In review of the literature, dual-device therapy is increasing in reports of use with combinations of VNS, RNS, and DBS to treat patients with drug-resistant epilepsy. We review dual-device implants with thalamic DBS device combinations, functional neural networks, and programming patients with dual devices. CM-Pf is a new target for DBS and has shown a variable response in focal epilepsy. We report the unique case of 28-year-old male with drug-resistant focal epilepsy who experienced a 75% seizure reduction with CM-Pf DBS as his third device after suboptimal responses to VNS and RNS. After 9 months, he also experienced seizure freedom from recurrent focal to bilateral tonic–clonic seizures. No medical or surgical complications or safety issues were encountered.

Conclusion

We demonstrate safety and feasibility in an adult combining active VNS, RNS, and CM-Pf DBS. Patients with dual-device therapy who experience a suboptimal response to initial device use at optimized settings should not be considered a neuromodulation “failure.” Strategies to combine devices require a working knowledge of brain networks.

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多神经调节治疗癫痫的 CM-Pf 深部脑刺激疗法。

目的：对于耐药性癫痫患者来说，神经调控是一种可行的选择。我们回顾了使用两种脑深部神经刺激器的患者的治疗情况。此外，本报告还补充了植入以中央-副筋膜（CM-Pf）核复合体为靶点的装置的患者，为植入三个有源装置并进行编程的患者提供了一个说明性病例：利用 PubMed 和 Embase 进行了一项叙述性综述，确定了植入一种以上神经刺激器的耐药性癫痫患者。我们发现了迷走神经刺激（VNS）、脑深部刺激（DBS）和反应性神经刺激（RNS）的组合。我们提供了一个新报道病例的背景资料，该病例是一名成人，在接受 VNS 和 RNS 治疗后疗效不佳，最终使用 CM-Pf DBS 作为第三个植入物：根据文献回顾，双设备疗法的报道越来越多，包括使用 VNS、RNS 和 DBS 组合治疗耐药癫痫患者。我们对丘脑 DBS 装置组合的双装置植入、功能神经网络以及使用双装置对患者进行编程进行了综述。CM-Pf 是 DBS 的新靶点，在局灶性癫痫中显示出不同的反应。我们报告了一例独特的病例：28 岁的男性患者患有耐药性局灶性癫痫，在使用 VNS 和 RNS 反应不佳的情况下，使用 CM-Pf DBS 作为其第三个装置后，癫痫发作减少了 75%。9 个月后，他还摆脱了复发性局灶性强直阵挛发作。没有出现医疗或手术并发症或安全问题：我们证明了在一名成年人身上结合使用主动 VNS、RNS 和 CM-Pf DBS 的安全性和可行性。采用双设备治疗的患者，如果在优化设置下使用初始设备时出现不理想的反应，不应被视为神经调节 "失败"。组合设备的策略需要对大脑网络有所了解。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Epileptic Disorders 医学-临床神经学

CiteScore

4.10

自引率

8.70%

发文量

138

审稿时长

6-12 weeks

期刊介绍： Epileptic Disorders is the leading forum where all experts and medical studentswho wish to improve their understanding of epilepsy and related disorders can share practical experiences surrounding diagnosis and care, natural history, and management of seizures. Epileptic Disorders is the official E-journal of the International League Against Epilepsy for educational communication. As the journal celebrates its 20th anniversary, it will now be available only as an online version. Its mission is to create educational links between epileptologists and other health professionals in clinical practice and scientists or physicians in research-based institutions. This change is accompanied by an increase in the number of issues per year, from 4 to 6, to ensure regular diffusion of recently published material (high quality Review and Seminar in Epileptology papers; Original Research articles or Case reports of educational value; MultiMedia Teaching Material), to serve the global medical community that cares for those affected by epilepsy.