响应神经刺激

反应性神经刺激(RNS)是一种 epilepsy 不需要手术切除脑组织的治疗方法. RNS uses an implanted device to help prevent seizures before they begin, 类似于心脏起搏器如何检测和治疗异常的心律.

With RNS, surgeons implant a small battery-powered device called a neurostimulator in the patient's skull. 神经刺激器与细导线相连, 叫领导, which the surgeon places in the area or areas of the brain where the patient's seizures originate. 神经刺激器监测大脑的电活动, 当检测到可能导致癫痫发作的活动时, 它通过导线传递电刺激脉冲. 电脉冲可能会在癫痫发作前停止.

接受RNS治疗的患者继续服用抗癫痫药物, 但他们的癫痫发作可能比单独用药更好控制. 因为没有脑组织被移除, 与其他手术治疗相比，RNS对患者的风险更小. Unlike conventional epilepsy surgery, RNS is reversible and the implant can be removed at any time.

The UCSF癫痫中心是西海岸最早提供RNS的中心之一吗. 我们的项目使用一种叫做NeuroPace的设备, which the FDA approved in 2013 to treat medically refractory epilepsy — epilepsy that is not well controlled by medication — in certain types of patients.

在临床试验中, nearly half the NeuroPace patients saw the frequency of their seizures decrease by at least 50 percent one year after implantation. 这种功效似乎也会随着时间的推移而增强. Three to six years after surgery, the median decrease in seizures was 60 percent or more.

谁是候选人??

You may be a good candidate for RNS if you meet the following criteria:

你有部分(局灶性)发作性癫痫.
你的癫痫发作源于大脑的一两个区域.
Your seizures are frequent and disabling, even after trying two or more anti-seizure medications.

RNS can be a good alternative to other surgical treatments if your seizures arise from an area of the brain that serves a critical function like speech or movement, making it difficult or impossible to surgically remove the seizure-causing tissue.

一组神经学家, neurosurgeons and other epilepsy experts will examine your particular case to determine if you are a good candidate for RNS.

继续阅读

过程

Before surgery, you will undergo diagnostic tests to pinpoint where seizures originate in your brain. The surgical team will use the results to determine how many leads to use and where to place them in the brain.

植入过程通常需要三到四个小时. The surgeon will make at least one incision in the scalp and skull to place the neurostimulator and leads. The incisions to place the leads are usually about the size of a quarter but may be larger. The neurostimulator is usually implanted on the side and toward the back of the head.

The device is turned on in the operating room and initially programmed only to record brain activity, 没有电刺激. The device will be programmed to deliver responsive stimulation in a follow-up visit to the center.

Most patients spend one night in the hospital and are discharged the following day.

Recovery

手术后大约10到14天, you will visit the 癫痫中心 to check how your incisions are healing and how many seizures have been recorded. Your doctor will then program the device to deliver stimulation when abnormal brain activity is detected. The neurostimulator will also continue to collect data on your brain activity.

大多数病人感觉不到电脉冲. If you do experience head pain or a brief tingling sensation in your scalp, please notify your doctor so the settings on the neurostimulator can be adjusted.

You will return to the 癫痫中心 four to six weeks after surgery, 之后每三个月一次, 来监测RNS的工作情况. 可能需要长达一年的时间才能看到RNS的全部效果, and the frequency of seizures appears to continue to decline over time.

You will be given a remote monitor that allows you to collect data from the neurostimulator and send it to your doctor. Your doctor will use the data to fine-tune the system's settings at future visits. The system also includes a magnet that instructs the neurostimulator to record brain activity when you swipe it over the implant site during a seizure. 你也可以使用磁铁暂时停止刺激.

你会收到一张钱包大小的医疗植入物识别卡. 请随时带着这张卡. You will need to show it when going through security systems at airports or elsewhere.

设备植入后, you must avoid certain medical treatments that could cause energy to travel through the device to the brain, 导致脑损伤或死亡. These include MRI, diathermy, electroconvulsive therapy and transcranial magnetic stimulation.

The neurostimulator's battery generally lasts about two-and-a-half to four years. When your battery is low, you will need to have the neurostimulator surgically replaced. 除非引线也需要更换, 新的神经刺激器也会连接到同样的导线上.

For more information, please contact one of our epilepsy nurse specialists:

神经学:
Maritza Lopez， (415) 353-2134

神经外科:
玛丽安·沃德，(415)353 -2347

加州大学旧金山分校健康医学专家已经审查了这些信息. It is for educational purposes only and is not intended to replace the advice of your doctor or other health care provider. We encourage you to discuss any questions or concerns you may have with your provider.