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首页> 外文期刊>Journal of neurology >Safety and feasibility of nucleus accumbens stimulation in five patients with epilepsy
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Safety and feasibility of nucleus accumbens stimulation in five patients with epilepsy

机译：5例癫痫伏伏伏核刺激的安全性和可行性

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In five adult patients with intractable partial epilepsy, safety and feasibility of chronic bilateral electrical stimulation of the nucleus accumbens (NAC) were assessed, also providing initial indications of therapeutic efficacy. Concurrent medication remained unchanged. In this phase 1 trial, clinical outcome parameters of interest were Quality of Life in Epilepsy questionnaire (QOLIE-31-P), Beck Depression Inventory, Mini International Neuropsychiatric Interview, neuropsychological testing, and Liverpool Seizure Severity Scale. Those data were obtained after 6 months of NAC stimulation and compared to the equivalent assessments made directly before implantation of electrodes. Additionally, monthly frequencies of simple partial seizures, complex partial seizures (CPS), and generalised tonic-clonic seizures (GTCS) were assessed during 3 months before electrode implantation and at the end of 6-month NAC stimulation. Proportion of responders, i.e. e50 % reduction in frequency of disabling seizures (sum of CPS and GTCS), was calculated. Main findings were unchanged psychiatric and neuropsychological assessment and a significant decrease in seizure severity (p = 0.043). QOLIE-31-P total score trended towards improvement (p = 0.068). Two out of five participants were responders. The median reduction in frequency of disabling seizures was 37.5 %. In summary, we provide initial evidence for safety and feasibility of chronic electrical stimulation of the NAC in patients with intractable partial epilepsy, as indicated by largely unchanged neurocognitive function and psychiatric comorbidity. Even though our data are underpowered to reliably assess efficacy, the significant decrease in seizure severity provides an initial indication of antiictal efficacy of NAC stimulation. This calls for larger and at best randomised trials to further elucidate efficacy of NAC stimulation in patients with pharmacologically intractable epilepsy.
机译：在五名患有顽固性部分癫痫的成年患者中，评估了伏伏核（NAC）的慢性双侧电刺激的安全性和可行性，也提供了治疗效果的初步指标。并发用药保持不变。在此1期试验中，感兴趣的临床结局参数为癫痫生活质量问卷（QOLIE-31-P），贝克抑郁量表，迷你国际神经精神病学访谈，神经心理学测试和利物浦癫痫发​​作严重程度量表。这些数据是在NAC刺激6个月后获得的，并与直接植入电极之前所做的等效评估进行了比较。此外，在电极植入前3个月和6个月NAC刺激结束时，评估了简单部分发作，复杂部分发作（CPS）和全身性强直阵挛性发作（GTCS）的每月频率。计算了响应者的比例，即禁用癫痫发作的频率降低了50％（CPS和GTCS的总和）。主要发现是精神病学和神经心理学评估未改变，癫痫发作严重程度明显降低（p = 0.043）。 QOLIE-31-P总得分趋于改善（p = 0.068）。五分之二的参与者是响应者。致残性癫痫发作频率的中位数降低为37.5％。总之，我们为顽固性部分性癫痫患者长期电刺激NAC的安全性和可行性提供了初步证据，这在很大程度上未改变神经认知功能和精神病合并症。即使我们的数据不足以可靠地评估疗效，癫痫发作严重程度的显着降低也提供了NAC刺激的抗痛药疗效的初步指标。这就需要进行更大范围的随机试验，以进一步阐明NAC刺激在药理上难治性癫痫患者中的疗效。

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