Neuromodulation in Children with Drug-Resistant Epilepsy

IF 0.2 Q4 PEDIATRICS
I. Ali, Kimberly Houck, K. Sully
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引用次数: 1

Abstract

Abstract The introduction of neuromodulation was a revolutionary advancement in the antiseizure armamentarium for refractory epilepsy. The basic principle of neuromodulation is to deliver an electrical stimulation to the desired neuronal site to modify the neuronal functions not only at the site of delivery but also at distant sites by complex neuronal processes like disrupting the neuronal circuitry and amplifying the functions of marginally functional neurons. The modality is considered open-loop when electrical stimulation is provided at a set time interval or closed-loop when delivered in response to an incipient seizure. Neuromodulation in individuals older than 18 years with epilepsy has proven efficacious and safe. The use of neuromodulation is extended off-label to pediatric patients with epilepsy and the results are promising. Vagus nerve stimulation (VNS), responsive neurostimulation (RNS), and deep brain stimulation (DBS) are Food and Drug Administration-approved therapeutic techniques. The VNS provides retrograde signaling to the central nervous system, whereas DBS and RNS are more target specific in the central nervous system. While DBS is open-loop and approved for stimulation of the anterior nucleus of the thalamus, the RNS is closed-loop and can stimulate any cortical or subcortical structure. We will review different modalities and their clinical efficacy in individuals with epilepsy, with a focus on pediatric patients.
儿童耐药癫痫的神经调节
神经调节的引入是治疗难治性癫痫的革命性进展。神经调节的基本原理是通过复杂的神经元过程,如破坏神经回路和放大边缘功能神经元的功能,将电刺激传递到所需的神经元部位,不仅在传递部位,而且在远处改变神经元的功能。当在设定的时间间隔内提供电刺激时,这种模式被认为是开环的;当响应于早期癫痫发作时,这种模式被认为是闭环的。18岁以上癫痫患者的神经调节已被证明是有效和安全的。神经调节的使用被扩展到标签外的儿童癫痫患者,结果是有希望的。迷走神经刺激(VNS),反应性神经刺激(RNS)和脑深部刺激(DBS)是食品和药物管理局批准的治疗技术。VNS向中枢神经系统提供逆行信号,而DBS和RNS在中枢神经系统中更具靶向特异性。DBS是开环的,被批准用于刺激丘脑前核,而RNS是闭环的,可以刺激任何皮层或皮层下结构。我们将回顾不同的治疗方式及其对癫痫患者的临床疗效,重点是儿科患者。
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来源期刊
自引率
0.00%
发文量
21
期刊介绍: The Journal of Pediatric Epilepsy is an English multidisciplinary peer-reviewed international journal publishing articles on all topics related to epilepsy and seizure disorders, epilepsy surgery, neurology, neurosurgery, and neuropsychology in childhood. These topics include the basic sciences related to the condition itself, the differential diagnosis, natural history, and epidemiology of seizures, and the investigation and practical management of epilepsy (including drug treatment, neurosurgery and non-medical and behavioral treatments). Use of model organisms and in vitro techniques relevant to epilepsy are also acceptable. Journal of Pediatric Epilepsy provides an in-depth update on new subjects and current comprehensive coverage of the latest techniques used in the diagnosis and treatment of childhood epilepsy.
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