基于脑机接口的反应性神经刺激术治疗药物难治性癫痫的研究进展

Research advances in responsive neurostimulation based on a brain-computer interface for the treatment of medically intractable epilepsy

摘要:

反应性神经刺激术（RNS）是一种基于脑机接口的闭环神经刺激术，通过植入颅内的电极实时接收和识别与癫痫发作相关的异常脑电，通过特定算法预测癫痫脑电发作并触发相应的电刺激以减少或控制癫痫发作。自2013年美国食品药品监督管理局（FDA）批准RNS治疗难治性癫痫以来，有较多的临床报道证实RNS的有效性与安全性，目前国内也开展了RNS的临床试验工作。近年来的研究表明，RNS在减少癫痫发作频率和提高患者生活质量方面表现出较好的长期疗效，但仍需进一步优化设备及算法，以提高治疗精准度和安全性。该文围绕RNS的闭环刺激机制、疗效、安全性及未来发展方向等方面进行综述，从而使更多临床工作者了解该项技术和其研究进展。

Abstract:

Responsive neurostimulation （RNS） is a closed-loop neuromodulation technique based on a brain-computer interface （BCI）. By implanting intracranial electrodes， the system continuously monitors and detects abnormal electroencephalographic （EEG） patterns associated with epileptic seizures， and RNS uses advanced algorithms to predict impending seizures and deliver targeted electrical stimulation， thereby mitigating or suppressing seizure activity. Since RNS was approved by the U.S. Food and Drug Administration （FDA） for the treatment of intractable epilepsy in 2013， a number of clinical studies have confirmed the efficacy and safety of RNS， and clinical trials of RNS have also been conducted in China. Recent studies have shown that RNS has good long-term efficacy in reducing seizure frequency and improving the quality of life of patients， but device components and stimulation algorithms should be further optimized to improve the precision and safety of treatment. This article reviews the closed-loop stimulation mechanisms， therapeutic efficacy evaluations， safety assessments， and future development trajectories of RNS， in order to improve the understanding of this technique and related research advances among clinicians.