摘要：

目的 探讨双侧丘脑前核电刺激术治疗药物难治性癫痫的效果及其发生机制。方法 共3 例药物难治性癫痫患者行双侧丘脑前核电刺激术治疗，手术前后记录癫痫发作频率、发作类型、抗癫痫药物种类和剂量，以及影像学和脑电图结果。结果 例1 术后随访28 个月，仅在漏服抗癫痫药物情况下出现1 次发作，复查视频脑电图，偶见单个棘-慢复合波，发作控制率达100%。例2 术后随访24 个月，复查视频脑电图，发作间期呈右侧额区-中央区-顶区慢波，发作频率减少25%。例3 术后随访3 个月，复查视频脑电图，发作间期弥漫性棘-慢复合波减少，双侧枕区棘-慢复合波，发作频率减少55%。3 例患者术后抗癫痫药物种类和剂量不变。结论 脑深部电刺激术是治疗药物难治性癫痫的有效方法，可以明显减少发作频率或完全控制发作，从而改善患者生活质量。

关键词: 癫痫, 深部脑刺激法, 前丘脑核, 脑电描记术

Abstract:

Objective  To study the efficacy and possible mechanism of deep brain stimulation (DBS) in bilateral anterior thalamic nuclei (ATN) for drug-resistant epilepsy. Methods  Three cases with drug-resistant epilepsy underwent DBS in bilateral ATN. Preoperative and postoperative assessment included the frequency of seizures, seizure types, kinds and dosage of anti-epileptic drugs (AEDs), and imaging and EEG examination. Results  Case 1 was followed up for 28 months, with only one seizure attack occurred due to missing doses. Video EEG (VEEG) during the follow-up period showed that a single unilateral spike-slow wave discharge was found by accident in one year after DBS. As for Case 2, intermittent time was significantly prolonged during the follow-up of 24 months. VEEG during the follow-up period showed interictal right frontal-central-parietal slow wave. Case 3 was followed up for 3 months, and VEEG examination during the follow-up period revealed decrease of diffuse spike-slow wave, while bilateral occipital spike-slow wave could be seen in interictal phase. Without any change of type and dose in taking AEDs after DBS, seizure frequency was reduced by 100% in Case 1, 25% in Case 2, and almost 55% in Case 3. Conclusions  DBS therapy is an effective treatment for drug-resistant epilepsy. It could significantly reduce the frequency of attacks, or even completely control the attack, and improve the patients' quality of life.

Key words: Epilepsy, Deep brain stimulation, Anterior thalamic nuclei, Electroencephalography