RESUMEN
BACKGROUND AND OBJECTIVES: The efficacy of deep brain stimulation of the anterior nucleus of the thalamus (ANT DBS) in patients with drug-resistant epilepsy (DRE) was demonstrated in the double-blind Stimulation of the Anterior Nucleus of the Thalamus for Epilepsy randomized controlled trial. The Medtronic Registry for Epilepsy (MORE) aims to understand the safety and longer-term effectiveness of ANT DBS therapy in routine clinical practice. METHODS: MORE is an observational registry collecting prospective and retrospective clinical data. Participants were at least 18 years old, with focal DRE recruited across 25 centers from 13 countries. They were followed for at least 2 years in terms of seizure frequency (SF), responder rate (RR), health-related quality of life (Quality of Life in Epilepsy Inventory 31), depression, and safety outcomes. RESULTS: Of the 191 patients recruited, 170 (mean [SD] age of 35.6 [10.7] years, 43% female) were implanted with DBS therapy and met all eligibility criteria. At baseline, 38% of patients reported cognitive impairment. The median monthly SF decreased by 33.1% from 15.8 at baseline to 8.8 at 2 years (p < 0.0001) with 32.3% RR. In the subgroup of 47 patients who completed 5 years of follow-up, the median monthly SF decreased by 55.1% from 16 at baseline to 7.9 at 5 years (p < 0.0001) with 53.2% RR. High-volume centers (>10 implantations) had 42.8% reduction in median monthly SF by 2 years in comparison with 25.8% in low-volume center. In patients with cognitive impairment, the reduction in median monthly SF was 26.0% by 2 years compared with 36.1% in patients without cognitive impairment. The most frequently reported adverse events were changes (e.g., increased frequency/severity) in seizure (16%), memory impairment (patient-reported complaint, 15%), depressive mood (patient-reported complaint, 13%), and epilepsy (12%). One definite sudden unexpected death in epilepsy case was reported. DISCUSSION: The MORE registry supports the effectiveness and safety of ANT DBS therapy in a real-world setting in the 2 years following implantation. CLASSIFICATION OF EVIDENCE: This study provides Class IV evidence that ANT DBS reduces the frequency of seizures in patients with drug-resistant focal epilepsy. TRIAL REGISTRATION INFORMATION: MORE ClinicalTrials.gov Identifier: NCT01521754, first posted on January 31, 2012.
Asunto(s)
Núcleos Talámicos Anteriores , Estimulación Encefálica Profunda , Epilepsia Refractaria , Epilepsia , Humanos , Femenino , Niño , Adolescente , Masculino , Estimulación Encefálica Profunda/efectos adversos , Calidad de Vida , Estudios Retrospectivos , Estudios Prospectivos , Tálamo , Epilepsia/etiología , Epilepsia Refractaria/terapia , Convulsiones/etiología , Sistema de RegistrosRESUMEN
The Anterior Nucleus of Thalamus (ANT) Deep Brain Stimulation (DBS) has long been touted as the most effective DBS-target for interrupting seizures in focal refractory epilepsy patients. The ANT is primarily involved in cognitive tasks but has extensive reciprocal connections with motor-related regions, suggesting that it is also involved in motor-cognitive tasks. In this work, we aimed to assess the involvement of the ANT during voluntary upper limbs movements. For this purpose, we analyzed Local Field Potentials (LFPs) signals recorded during a movement protocol from one of the first epilepsy patients implanted with a Percept™ PC system, who performed a 5-day period of simultaneous video electroencephalography (vEEG) and Percept PC-LFPs recordings. We estimated time-frequency maps and performed event-related desynchronization (ERD) or synchronization (ERS) analysis and we found that synchronizations found in left hemisphere 7-17 Hz map corresponded to maximum hand rotations. Positive peaks on the ERD/ERS curve occurred at a similar frequency of the hand movements ([Formula: see text] against [Formula: see text]). These results suggested that the ANT may be involved in the execution of automatisms. Moreover, we found that ERD/ERS appeared approximately 2 seconds before the movement onset, as it was found on the EEG of healthy subjects performing the same protocol.
Asunto(s)
Epilepsias Parciales , Epilepsia , Automatismo , Electroencefalografía , Epilepsia/diagnóstico , Humanos , Convulsiones , TálamoRESUMEN
Este artigo aborda a questao da bioenergia, tambem chamada de energia vital ou forca vital, partindo de um ponto de vista da psicoterapia reichiana e neo-reichiana. Sao discutidos os fundamentos cientificos e epistemologicos deste conceito e investigadas suas conexoes com a Homeopatia, a Acupuntura, terapias alternativas e tradicoes espirituais orientais e ocidentais. Verifica-se que, mesmo entre os que defendem a existencia de uma bioenergia, sao multiplas as opinioes sobre o tema, sendo estas incompativeis entre si em pontos fundamentais. Conclui-se pela necessidade de aprofundamento do assunto, e sao propostos alguns caminhos para tal
Asunto(s)
Medicina Tradicional China , Religión , VitalismoRESUMEN
Este artigo aborda a questao da bioenergia, tambem chamada de energia vital ou forca vital, partindo de um ponto de vista da psicoterapia reichiana e neo-reichiana. Sao discutidos os fundamentos cientificos e epistemologicos deste conceito e investigadas suas conexoes com a Homeopatia, a Acupuntura, terapias alternativas e tradicoes espirituais orientais e ocidentais. Verifica-se que, mesmo entre os que defendem a existencia de uma bioenergia, sao multiplas as opinioes sobre o tema, sendo estas incompativeis entre si em pontos fundamentais. Conclui-se pela necessidade de aprofundamento do assunto, e sao propostos alguns caminhos para tal