优化抗药癫痫的高频和低频深部脑刺激参数：机制、临床结果和未来方向

IF 0.5 Q4 CLINICAL NEUROLOGY

Interdisciplinary Neurosurgery: Advanced Techniques and Case Management Pub Date : 2025-08-05 DOI:10.1016/j.inat.2025.102109

Faeze Sadat Ahmadi Tabatabaei , Mohammad Taghi Joghataei , Kiana Askarian , Leila Riahi Pour , Bita Kouhnavard Pour , Nooshin Ahmadirad

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引用次数: 0

摘要

目的探讨深部脑刺激（DBS）中高频刺激（HFS）和低频刺激（LFS）治疗耐药癫痫（DRE）的作用机制、靶点选择和参数优化。方法综合临床前和临床研究，分析电极放置、刺激参数（频率、脉宽、强度）和DBS关键靶点（包括丘脑中央区、丘脑前侧和海马）的结果。新兴的非侵入性神经调节策略，如重复性经颅磁刺激（rTMS），在更广泛的治疗领域中得到了广泛的应用。结果shfs （100-130 Hz）通过破坏皮质同步和增强gaba能抑制，显示出强大的抗癫痫作用，在40 - 60%的DRE患者中实现持续的癫痫发作减少。LFS 1 - 10hz表现出不同的疗效，有通过皮质同步加剧癫痫发作的风险。最佳脉冲宽度（60-240 μs）和幅度（150-300 μA）需要根据具体患者进行校准。rTMS （0.3-1 Hz）显示出非侵入性调制致痫网络的辅助潜力，特别是当与神经成像相结合时。结论DBS是DRE的基础，但参数优化是平衡疗效和安全性的关键。未来的研究应优先考虑闭环系统，生物标志物驱动的方案，以及侵入性（DBS）和非侵入性（rTMS）神经调节之间的协同作用。

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Optimizing high-frequency and low-frequency deep brain stimulation parameters for drug-resistant epilepsy: Mechanisms, clinical outcomes, and future directions

Objective

This review evaluates the therapeutic potential of high-frequency stimulation (HFS) and low-frequency stimulation (LFS) in deep brain stimulation (DBS) for drug-resistant epilepsy (DRE), focusing on mechanisms, target selection, and parameter optimization.

Methods

A synthesis of preclinical and clinical studies was conducted, analyzing electrode placement, stimulation parameters (frequency, pulse width, intensity), and outcomes across key DBS targets, including the centromedian thalamus, anterior thalamus, and hippocampus. Emerging non-invasive neuromodulation strategies, such as repetitive transcranial magnetic stimulation (rTMS), were contextualized within the broader therapeutic landscape.

Results

HFS (100–130 Hz) demonstrates robust antiepileptic effects by disrupting cortical synchronization and enhancing GABAergic inhibition, achieving sustained seizure reduction in 40–60 % of DRE patients. LFS 1–10 Hz shows variable efficacy, with risks of exacerbating seizures via cortical synchronization. Optimal pulse widths (60–240 μs) and amplitude (150–300 μA) require patient-specific calibration. rTMS (0.3–1 Hz) exhibits adjunctive potential for non-invasive modulation of epileptogenic networks, particularly when combined with neuroimaging.

Conclusion

While DBS remains a cornerstone for DRE, parameter optimization is critical to balancing efficacy and safety. Future research should prioritize closed-loop systems, biomarker-driven protocols, and synergies between invasive (DBS) and non-invasive (rTMS) neuromodulation.

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