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脑深部电刺激治疗药物难治性癫痫的研究进展
2018-01-17 | 阅:  转:  |  分享 
  
·468·中华解剖与临床杂志2015年10月第20卷第5期摇ChinJAnatClin,October2015,Vol.20,No.5
[25]
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少有报道,但同样不可忽视,大致可归为以下三类。
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手术相关并发症:(1)颅内出血。手术本身及植入电极
anteriornucleusofthalamusfortreatmentofrefractoryepilepsy
的数量与出血直接相关,并随着植入电极的数量增加而增
[J].Epilepsia,2010,51(5):899鄄908.
加。(2)电极错位。刺激的有效性取决于准确的靶点定位。
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通常刺激靶点均为体积较小的脑深部核团,而植入靶点的电
thalamicnucleusstimulationforintractableepilepsy[J].Stereotact
极直径约为1.2mm,手术操作不当会导致电极偏离靶点而
FunctNeurosurg,2012,90(6):379鄄385.
影响治疗效果。
[12]TopraniS,DurandDM.Long鄄lastinghyperpolarizationunderlies
硬件相关并发症:(1)电极断裂。常发生在电极的颅骨
seizurereductionbylowfrequencydeepbrainelectricalstimulation
固定装置处。(2)电极移位。通常因电极固定方法不恰当导
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致。若电极固定不牢固,头颈部的反复运动会牵引电极导致[13]RashidS,PhoG,CziglerM,etal.Lowfrequencystimulationof
ventralhippocampalcommissuresreducesseizuresinaratmodelof
其移位。(3)感染和皮肤溃疡。
chronictemporallobeepilepsy[J].Epilepsia,2012,53(1):
刺激相关并发症:(1)感觉运动异常。最为常见,如肢体
147鄄156.
活动障碍、言语障碍等。(2)精神异常。部分病例可见抑郁
[14]ChenN,GaoY,YanN,etal.High鄄frequencystimulationofthe
和躁狂。
hippocampusprotectsagainstseizureactivityandhippocampal
neuronalapoptosisinducedbykainicacidadministrationin
4摇展望
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新近研究表明,使用DBS治疗不适合常规手术的药物难
[15]VelascoAL,VelascoF,VelascoM,etal.Electricalstimulationof
治性癫痫的疗效值得肯定;但目前尚缺少大样本随机对照试
thehippocampalepilepticfociforseizurecontrol:adouble-
验结果的支持,对于不同类型的癫痫,刺激靶点和刺激参数blind,long鄄termfollow鄄upstudy[J].Epilepsia,2007,48(10):
1895鄄1903.
的选择也无统一定论。然而,DBS手术适应证相对较广,可
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选择的治疗靶点多样,患者的耐受性高,相信随着基础和临
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床研究的不断深入,DBS治疗难治性癫痫会展示出广阔的应
EpilepsyRes,2012,99(1鄄2):87鄄93.
用前景。
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(收稿日期:2014鄄11鄄22)
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