摘要：

目的: 探讨海马-杏仁核脑深部电刺激术（AH-DBS）治疗难治性内侧颞叶癫痫的长期疗效及其对认知功能的影响。方法: 共纳入2014年1月至2018年12月解放军总医院第一医学中心收治的7例难治性内侧颞叶癫痫患者，均行AH-DBS，对比手术前后癫痫发作形式、发作频率和抗癫痫发作药物应用情况，采用韦氏成人智力量表修订版（WAIS-R）评估认知功能；术后记录刺激参数以及手术相关并发症。结果: 共7例患者行双侧AH-DBS 4例，左侧AH-DBS 2例，左侧AH-DBS联合右侧颞前叶切除术1例；经枕部入路6例，经额部入路1例；仅1例患者术后出现头皮切口愈合不良，经局部植皮后痊愈。术后平均随访（73.00 ±8.98）个月，随访期间复杂部分性发作频率[1.00（0.00，31.00）次/月对2.00（1.50，60.00）次/月；Z=-2.207，P=0.027]、继发性全面性强直-阵挛发作频率[0.00（0.00，1.00）次/月对2.00（1.00，3.00）次/月；Z=-2.428，P=0.015]和总发作频率[1.00（0.50，31.00）次/月对5.00（2.50，64.00）次/月；Z=-2.366，P=0.018]均较术前减少，而手术前后抗癫痫发作药物种类[1.00（1.00，2.00）种对1.00（1.00，3.00）种；Z=-1.633，P=0.102]和WAIS-R评分[（85.50 ±7.09）分对（89.00 ±9.47）分；t=-1.761，P=0.078]差异无统计学意义。结论: AH-DBS作为一种新型抗癫痫治疗方法，可以减少难治性内侧颞叶癫痫发作频率，无严重不良事件，且对认知功能无明显影响。

关键词: 癫痫，颞叶, 深部脑刺激法, 海马, 杏仁核, 认知

Abstract:

Objective: To investigate the long-term efficacy of amygdala- hippocampus deep brain stimulation (AH-DBS) in treating refractory medial temporal lobe epilepsy (mTLE) and its impact on cognitive function. Methods: Seven patients with refractory mTLE who were treated at The First Medical Center of Chinese PLA General Hospital from January 2014 to December 2018 were enrolled in this study. All 7 patients underwent AH-DBS. Seizure types, seizure frequency, and antiepileptic seizure medicine (ASM) usage were compared before and after surgery. Cognitive function was assessed using Wechsler Adult Intelligence Scale-Revised (WAIS-R). Post-operative stimulation parameters and surgery-related complications were recorded. Results: Of the 7 patients, 4 patients received bilateral AH-DBS, 2 patients received left AH-DBS, and one patient received left AH-DBS combined with right anterior temporal lobectomy. There were 6 patients underwent the occipital approach, and one patient underwent the frontal approach. Only one patient experienced poor healing of the scalp incision, which healed after local skin grafting. The mean follow-up period was (73.00 ±8.98) months. During the follow-up period, there were reductions in complex partial seizure (CPS) frequency [1.00 (0.00, 31.00) times per month vs. 2.00 (1.50, 60.00) times per month; Z =-2.207, P = 0.027], secondary generalized tonic-clonic seizure (SGTCS) frequency [0.00 (0.00, 1.00) times per month vs. 2.00 (1.00, 3.00) times per month; Z =-2.428, P = 0.015], and the total seizure frequency [1.00 (0.50, 31.00) times per month vs. 5.00 (2.50, 64.00) times per month; Z =-2.366, P = 0.018]. However, there were no significant differences in the number of ASM types [1.00 (1.00, 2.00) types vs. 1.00 (1.00, 3.00) types; Z =-1.633, P = 0.102] or WAIS-R [(85.50 ±7.09) scores vs. (89.00 ±9.47) scores; t =-1.761, P = 0.078] before and after surgery. Conclusions: As a novel anti-epileptic treatment method, AH-DBS can reduce the frequency of refractory mTLE without serious adverse events and has no significant impact on cognitive function.

Key words: Epilepsy, temporal lobe, Deep brain stimulation, Hippocampus, Amygdala, Cognition