Cov ntaub ntawv pov thawj rau kev nco ntev hauv Focal Seizure Duration

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Lub Hom Phiaj Paub Txog: Ib qho tseem ceeb ntawm kev xiam oob khab rau cov neeg mob qaug dab peg cuam tshuam nrog kev tsis paub meej nyob ib puag ncig lub sijhawm qaug dab peg thiab qhov hnyav. Txawm hais tias cov neeg mob feem ntau tshaj tawm tias kev qaug dab peg ntev ntev tsis tau ua raws li kev qaug dab peg hnyav dua, muaj cov pov thawj me me los txhawb qhov kev soj ntsuam no. Optimal characterization ntawm qaug dab peg hnyav yog debated; Txawm li cas los xij, lub sijhawm qaug dab peg yog txuam nrog hom qaug dab peg thiab tuaj yeem suav tau hauv cov ntaub ntawv electrographic raws li qhov txwv tsis pub muaj kev cuam tshuam ntawm kev kho mob qaug dab peg. Ntawm no, siv cov kab mob intracranial electroencephalography (cEEG), peb tshawb xyuas qhov kev sib raug zoo ntawm qhov sib txawv ntawm qhov sib txawv (ISI) thiab lub sijhawm ntawm kev qaug dab peg tom ntej. Cov Txheej Txheem: Peb tau ua qhov kev soj ntsuam rov qab ntawm 14 yam kev cog lus nrog cov khoom siv neurostimulation teb (RNS System) uas muab cEEG, suav nrog cov ntawv teev sijhawm ntawm electrographic qaug dab peg. Peb tau txiav txim siab qaug dab peg rau kev qaug dab peg thiab rau cov neeg sawv cev qaug dab peg los ntawm pawg txiav txim los ntawm txoj kev tsis saib xyuas. Rau txhua qhov kev kawm, qhov nruab nrab ISI ua ntej kev qaug dab peg ntev, txhais tau hais tias yog qhov saum toj kawg nkaus quintile ntawm kev qaug dab peg, tau muab piv nrog qhov nruab nrab ISI ua ntej qaug dab peg nrog lub sijhawm ntawm cov quintiles seem. Hauv kev txheeb xyuas pab pawg, qhov nruab nrab ntawm qhov qaug dab peg thiab qhov feem ntawm kev qaug dab peg ntev tau muab piv rau cov ISI pawg sawv cev rau qhov ntev sib txawv. Cov txiaj ntsig: Rau 5 tawm ntawm 14 yam kev kawm (36 feem pua), qhov nruab nrab ISI ua ntej kev qaug dab peg ntev tau loj dua li qhov nruab nrab ISI ua ntej luv luv-ntev qaug dab peg. Hauv kev txheeb xyuas pab pawg, thaum ISI raug cais los ntawm qhov ntev, qhov kev faib ua feem ntawm kev qaug dab peg ntev nyob rau hauv qib siab ISI tau nce siab dua li ntawm qeb ISI qis (P < 0.001).="" qhov="" tseem="" ceeb:="" los="" ntawm="" leveraging="" ceeg="" thiab="" accounting="" rau="" pawg="" qaug="" dab="" peg,="" peb="" pom="" tau="" hais="" tias="" qhov="" tshwm="" sim="" ntawm="" kev="" qaug="" dab="" peg="" ntev="" mus="" zoo="" sib="" xws="" nrog="" isi="" ntev,="" nyob="" rau="" hauv="" ib="" pawg="" ntawm="" cov="" tib="" neeg.="" cov="" kev="" tshawb="" pom="" no="" tau="" txheeb="" xyuas="" qhov="" kev="" soj="" ntsuam="" kev="" soj="" ntsuam="" thiab="" txhawb="" nqa="" lub="" neej="" ntawm="" capacitor="" zoo="">nco ntevcov txheej txheem tswj cov dynamics ntawm focal qaug dab peg.

Nyem rau Cistanches thiab Cistanche kom nco

KEYWORDS capacitative effect, chronic EEG, interseizure interval, teb neurostimulation

Joline M. Fan, Sharon Chiang, Vikram R. Rao

Department of Neurology thiab Weill lub koom haum rau Neurosciences, University of California, San Francisco, San Francisco, CA, USA

1 QHOV TSEEB

Kev qaug dab peg tsis muaj tseeb yog ib yam uas cuam tshuam tsis zoo rau kev qaug dab peg.1 Qhov kev tsis txaus ntseeg muaj feem cuam tshuam tsis yog rau lub sijhawm qaug dab peg xwb tab sis kuj ua rau qaug dab peg.2–4 Piv txwv li, ib qho kev qaug dab peg ntev yuav ua rau muaj kev mob hnyav dua li ib pawg ntawm cov lus sib tham luv luv. . Txawm hais tias txoj hauv kev los kwv yees lub sijhawm qaug dab peg tau tshwm sim, 5 txoj hauv kev los cia siab tias qaug dab peg tseem tsis muaj.6,7

Ib qho kev soj ntsuam kev soj ntsuam ua los ntawm cov neeg mob yog tias lub sij hawm ntev ntawm kev qaug dab peg yuav tshwm sim ua rau muaj kev qaug dab peg ntau dua.6 Yog tias lub sij hawm txij li qhov kev qaug dab peg dhau los qhia txog qhov hnyav ntawm kev qaug dab peg yav tom ntej, kev qaug dab peg cov qauv yuav muaj peev xwm muab cov ntaub ntawv hais txog kev mob tshwm sim. ntawm kev qaug dab peg yav tom ntej. Txawm li cas los xij, cov pov thawj sim los txhawb qhov kev soj ntsuam no tau txwv vim qhov xav tau qhov tseeb, ntau qhov ntsuas ntawm kev qaug dab peg. Txawm hais tias ntau qhov ntsuas tau raug tsim los ntes kev xav paub txoj kev mob siab rau lub luag haujlwm dhau los, 2,8-11 feebification ntawm ib tug neeg qaug dab peg tseem nyuaj. Lub sijhawm qaug dab peg tau pom tias muaj feem cuam tshuam rau qaug dab peg hom 12-16-focal paub, focal impaired awareness, los yog focal rau ob tog tonic-clonic-thiab rau qaug dab peg.17 Muab cov koom haum no, kev qaug dab peg yuav ua rau pom qhov pom ntawm lub cev thiab qhov hnyav. ntawm tus kheej qaug dab peg, thiab, qhov tseem ceeb, tuaj yeem soj ntsuam ntau los ntawm kev kaw cia ntev.

Hauv txoj kev tshawb no, peb siv RNS System los qhia txog kev sib raug zoo ntawm ISI thiab lub sijhawm qaug dab peg. Cov kev tshawb fawb pib siv NeuroVista dataset los tshawb xyuas qhov kev sib raug zoo ntawm kev qaug dab peg thiab ISI6,23 tau pom cov pawg sib txawv ntawm kev qaug dab peg thiab ISI hauv qee yam kev kawm; nyob rau hauv ob ntawm kaum tsib yam kev kawm, kev qaug dab peg luv luv tau txheeb xyuas nrog luv ISI.6 Lwm cov kev tshawb fawb, suav nrog hauv cov qauv kab mob vwm, 24 qhia tias kev sib raug zoo ntawm ISI yav dhau los thiab lub sijhawm qaug dab peg txawv ntawm cov kev kawm. Qhov kev hloov pauv no tuaj yeem cuam tshuam txog qhov cuam tshuam ntawm pawg qaug dab peg, uas tsis suav nrog hauv cov kev tshuaj ntsuam no, thiab tuaj yeem ua rau pom qhov cuam tshuam ntawm kev qaug dab peg "nco" ntawm cov xwm txheej ua ntej. Ntawm no, peb nrhiav kom paub meej txog kev sib raug zoo ntawm ISI yav dhau los thiab lub sijhawm qaug dab peg los ntawm (a) siv cov ntaub ntawv sib txawv uas cuam tshuam nrog rau lub sij hawm ntev cEEG los ntawm RNS System, (b) accounting rau qaug dab peg, thiab (c) muab Raws li kev soj ntsuam soj ntsuam, peb xav tias qhov ntev ntawm ISI kwv yees lub sijhawm qaug dab peg.

2 txoj kev

2.1 Kev xaiv hom

Plaub caug-tsib cov kev kawm ua raws li hauv University of California, San Francisco (UCSF) Medical Center rau kev kho mob refractory focal epilepsy thiab implanted nrog RNS System rau kev soj ntsuam ntshiab ntawm 8/2014 thiab 2/2018 tau txiav txim siab rau txoj kev tshawb no. Kev sau cov ntaub ntawv tau pom zoo los ntawm IRB ntawm UCSF, thiab sau ntawv tso cai tau txais los ntawm txhua yam kev kawm.

2.2 Kev sau cov ntaub ntawv

Sijhawm thiab lub sijhawm ntev ntev (LE), kev tshawb nrhiav txuas ntxiv ntawm kev ua haujlwm ntawm tus kabmob epileptiform tshaj li lub sijhawm teem tseg, tau txais los ntawm NeuroPace, Inc Txhawm rau txiav txim siab qhov twg LE sawv cev rau electrographic qaug dab peg, kev tshuaj xyuas pom ntawm RNS System electrocorticograms (ECoGs) uas muaj LE yog ua los ntawm tus kws paub txog mob vwm (VRR), raws li tau piav qhia yav dhau los.18 Thaum lub sijhawm txhua lub sijhawm ntawm cov khoom siv ruaj khov nrhiav kom pom, tag nrho cov ECoGs uas muaj LE tau raug tshuaj xyuas.18 Nees nkaum tsib qhov kev kawm tau txheeb xyuas rau leej twg LE yog qhov ntsuas tau zoo ntawm electrographic qaug dab peg nrog tus nqi kwv yees zoo (PPV) ntau dua 75 feem pua. Cov ncauj lus uas muaj tsawg dua 15 qhov sib cais los yog pawg, lossis kev qaug dab peg ntau dua 1 hauv ib hnub, raug cais tawm vim muaj qhov sib txawv ntawm qhov ntev ntawm ISI, tawm tag nrho ntawm 14 cov ntsiab lus suav nrog hauv txoj kev tshawb no. LE timestamps thiab ncua sij hawm tau txais los ntawm lub sijhawm ntev tshaj plaws ntawm kev tshawb nrhiav ruaj khov rau txhua qhov kev kawm. Kev txheeb xyuas lub sijhawm nrog qhov chaw ruaj khov yog qhov tseem ceeb, txhawm rau kom tsis txhob muaj qhov sib txawv tsuas yog tshwm sim los ntawm kev hloov pauv hauv qhov pib lossis kev tshawb pom cov txheej txheem ntawm kev ua ub ua no.

2.3 Kev ua cov ntaub ntawv

MATLAB R2019a tau siv rau kev tshuaj xyuas. Cov pawg qaug dab peg tau txhais tau tias siv qhov tsis muaj kev saib xyuas ib ntus pawg los ntawm kev hloov pauv cov ntsiab lus nrog bootstrapping. Txoj hauv kev no tso cai rau kev tshawb nrhiav tsis pom kev qaug dab peg thaum ua kom muaj kev hloov kho kom ua tau raws li cov txheej txheem kho mob.25 Qhov kev hloov pauv ntawm qhov pib yog ib qho kev hloov kho ntawm tus kheej uas suav nrog qhov sib txawv ntawm kev qaug dab peg cuam tshuam rau lub ntsiab lus ntawm pawg qaug dab peg. Qhov kev hloov pauv qhov pib tau titrated rau txhua qhov kev kawm raws li ob yam: (a) Qhov siab tshaj plaws intracluster ISI yog nyob nruab nrab ntawm 6 thiab 24 teev, thiab (b) qhov nruab nrab intracluster ISI yog ze tshaj rau 1.5 teev tsis pub tshaj 1.5 teev, nyob ntawm qhov kev taw qhia ntawm titration (piv txwv li, yog tias qhov nruab nrab intracluster ISI qis dua 1.5 teev, tus nqi tau nce los ua tus nqi siab tshaj plaws tsawg dua 1.5 teev, thiab rov qab yog tias siab dua 1.5 teev). Txawm hais tias tam sim no tsis muaj cov qauv txheej txheem los kho qhov hloov pauv qhov pib, qhov txheej txheem titration no tau ua kom muaj kev sib koom ua ke ntawm tus kheej xws li qhov chaw qis dua tau siv rau cov neeg mob uas muaj kev qaug dab peg txhua hnub thiab cov qib siab dua tau siv rau cov kev kawm uas muaj qaug dab peg ntau dua. Tag nrho cov pawg neeg qaug dab peg tau raug tshuaj xyuas manually (JMF). Qhov nruab nrab intracluster ISI nyob ntawm 1.11 mus rau 2.78 teev, nrog rau qhov tshwj xeeb ntawm Kev Kawm 8, leej twg xav tau ntev intracluster ISI los ntes pawg vim muaj pes tsawg tus LEs (<5) involved="" in="" seizure="" clusters="" with="" relatively="" higher="" intracluster="" isis="" (table="" 2,="" figure="">

Rau txhua qhov kev qaug dab peg los yog kev qaug dab peg ntawm ib pawg, ISI tau suav tias yog lub sijhawm ntawm kev qaug dab peg thiab kev qaug dab peg tsis ntev los no lossis qhov kawg ntawm pawg qaug dab peg. Txhawm rau sib piv thoob plaws cov kev kawm hauv pab pawg kev tshuaj xyuas, ISIs tau raug ntsuas raws li tus qauv ntsuas los ntawm 0 rau 100. Cov kab sib npaug tau txiav txim siab los ntawm kev faib 100 los ntawm qhov siab tshaj plaws ISI rau txhua qhov kev kawm. Rau pawg qaug dab peg, lub sijhawm tus neeg sawv cev ntawm pawg qaug dab peg tau teem rau lub sijhawm ntev tshaj plaws ntawm kev qaug dab peg hauv pawg qaug dab peg thiab lub sijhawm ntawm pawg tau teem rau lub sijhawm ntawm thawj zaug qaug dab peg hauv pawg.

2.4 Kev txheeb cais

Ob txoj kev sib cais tau siv los ntsuas kev sib koom ua ke ntawm ISI thiab kev qaug dab peg rau ib tus neeg. Ua ntej, rau txhua qhov kev kawm, Wilcoxon xeem tau siv los ntsuas qhov sib txawv tseem ceeb hauv ISI ntev ntawm kev qaug dab peg ntev, txhais tau tias yog qaug dab peg nyob rau sab saum toj quintile ntawm qaug dab peg ntev, piv rau luv luv-ntev qaug dab peg, txhais tau tias yog cov nyob hauv cov quintiles residual. (hauv qab 80 feem pua) ntawm kev qaug dab peg. Kev txheeb xyuas qhov tseem ceeb tau txiav txim siab nrog tus lej nrhiav tsis tseeb (FDR) tswj ntawm 0.15. Thib ob, kmeans plus plus tau siv los ua pawg ISI ntev ntev rau hauv K=3 pawg sib raug rau "tsawg," " nruab nrab," thiab "siab" ISI ntev. Cluster centroids tau pib siv 25th, 50th, thiab 75th feem pua ​​​​ntawm ISIs thiab hloov pauv los ntawm lub ntuj tsim los pab kom muaj cov qauv txaus rau txhua pawg ISI. Qhov tshwm sim "tsawg," "nruab nrab," thiab "siab" ISI pawg tau pom hauv daim duab S2. rhiab heev ntawm kmeans ntxiv rau pab pawg rau K=2 thiab K=4 pawg tau ua ntxiv. Ib txoj kev ANOVA tau siv los ntsuas qhov sib txawv tseem ceeb ntawm qhov sib piv ntawm kev qaug dab peg ntev thiab txhais tau tias qaug dab peg ntawm ISI pawg. Post hoc pairwise qhov tseem ceeb ntawm kev txheeb xyuas tau raug kho rau ntau qhov kev sib piv nrog FDR ntawm 0.05.

3 TSEEM CEEB

3.1 Cov yam ntxwv ntawm pej xeem thiab kev ntsuas hluav taws xob ntau

Table 1 qhia cov pej xeem thiab RNS System yam ntxwv rau cov qauv kawm. Qhov nruab nrab hnub nyoog ntawm cov khoom cog yog 41.3 ± 15.1 xyoo. Qhov nruab nrab ntawm cov hnub uas muaj kev ruaj ntseg nrhiav tau yog 710 ± 276 hnub (ntau, 287-1385 hnub). Cov ntsiab lus sawv cev rau ntau yam ntawm RNS System cov chaw ua haujlwm, suav nrog ob sab hippocampal, neocortical, thiab sib xyaw (mesial temporal thiab neocortical). Rau qhov kev kawm muaj focal paub qaug dab peg (FAS) lossis focal impaired awareness qaug dab peg (FIAS) yam tsis muaj kev sib tham thib ob, thiab cuaj tus neeg muaj FAS thiab/lossis FIAS nrog focal rau ob tog tonic-clonic qaug dab peg (FBTCS). Table 2 qhia txog cov yam ntxwv ntawm kev txheeb xyuas electrographic qaug dab peg, suav nrog tus naj npawb nruab nrab ntawm electrographic qaug dab peg (LE) ib pawg, txhais tau tias inter-thiab intracluster ISI, qhov siab tshaj plaws intracluster ISI, thiab lub sijhawm nruab nrab ntawm cov pawg qaug dab peg. Qhov nruab nrab ntawm qaug dab peg ib pawg yog 3.0 ± 3.8 qaug dab peg (ntau 1-15; Table 2a). Qhov nruab nrab intercluster ISI, uas yog, ISI ntawm kev sib cais los yog qaug dab peg, muaj li ntawm 2 mus rau 32 hnub, qhia txog qhov sib txawv ntawm kev qaug dab peg los ntawm ze-txhua hnub mus rau txhua hli (Table 2b). Qhov nruab nrab inracluster ISI yog<3 hours="" (except="" for="" subject="" 8,="" see="" methods;="" figure="" s1)="" with="" a="" maximum="" intracluster="" isi="" between="" 6.4="" and="" 22.4="" hours="" (table="" 2d).="" the="" average="" of="" all="" maximum="" duration="" seizures="" within="" each="" cluster="" and="" isolated="" seizures="" is="" shown="" in="" table="" 2e.="" consistent="" with="" prior="" studies,12–14="" subjects="" with="" fas,="" for="" example,="" subjects="" 4="" and="" 5,="" tended="" to="" have="" short-duration="" seizures,="" whereas="" those="" subjects="" with="" fbtcs="" (subjects="" 3,="" 4,="" 6-9,="" 13,="" and="" 14)="" tended="" to="" have="" long-duration="">

3.2 Kev muab cov metrics ntawm qhov piv txwv

Lub sij hawm qaug dab peg nyob rau hauv ib qho kev kawm qhia tias qaug dab peg tshwm sim raws li cov xwm txheej sib cais thiab ua pawg (Daim duab 1A). Nyob rau hauv qhov sib piv rau cov kev soj ntsuam ua ntej ntawm pawg kho mob qaug dab peg, 17 pawg ntawm lub cev nqaij daim tawv tau txheeb xyuas los ntawm cov txheej txheem tsis muaj kev saib xyuas (saib Cov Txheej Txheem) tau qhia tias kev qaug dab peg nrog lub sijhawm ntev tshaj plaws nyob rau hauv pawg tsis tas yuav yog qhov kev tshwm sim davhlau ya nyob twg. Thoob plaws cov kev kawm, feem pua ​​​​ntawm cov pawg qaug dab peg uas lub sijhawm ntev tshaj plaws ntawm kev qaug dab peg poob ntawm lub davhlau ya nyob twg ntawm pawg yog 42 ± 18 feem pua ​​(ntau 15 feem pua ​​-83 feem pua). Txhawm rau kom suav nrog qhov sib txawv ntawm qhov kev sib txawv ntawm qhov ntev tshaj plaws ntawm kev qaug dab peg nyob rau hauv ib pawg, ib pawg qaug dab peg tau sawv cev los ntawm lub sijhawm pib ntawm thawj electrographic qaug dab peg thiab lub sijhawm qaug dab peg ntau tshaj plaws hauv pawg (Daim duab 1B, lub voj voog liab). Los ntawm kev suav nyiaj rau ob qho tib si sib cais thiab qaug dab peg, ib qho kev sib raug zoo ntawm ISI thiab lub sijhawm qaug dab peg yog qhia hauv tus neeg mob piv txwv (Daim duab 1C). Daim duab 1C txuas ntxiv muab ib qho piv txwv ntawm ISI pawg los ntawm qhov ntev thiab qhov pib siv rau kev qaug dab peg ntev, txhais tau hais tias yog quintile sab saum toj ntawm kev qaug dab peg ntev.

3.3 Kev sib piv ntawm ISI qhov ntev ntawm qhov ntev- thiab luv-ntev-kev qaug dab peg

Txhawm rau txiav txim siab seb qhov kev qaug dab peg ntev npaum li cas tau cuam tshuam nrog ISI ntev dua, kev faib tawm ntawm ISIS ua ntej kev qaug dab peg ntev dua li piv rau qhov kev qaug dab peg luv dua, uas yog, qhov seem seem, rau txhua qhov kev kawm. Raws li pom nyob rau hauv daim duab 2, nyob rau hauv tsib ntawm kaum plaub yam kev kawm (36 feem pua), qhov nruab nrab ISIs ua ntej lub sij hawm qaug dab peg tau ntev dua li qhov nruab nrab ISIs ua ntej luv luv-ntev qaug dab peg los ntawm qhov nruab nrab ntawm 17.6 ± 14.8 hnub. Qhov kev faib tawm, qhov nruab nrab, thiab qhov nruab nrab uas sawv cev rau txhua yam kev kawm yog qhia hauv daim duab S3 thiab Table S1.

3.4 Pab pawg sib piv ntawm kev qaug dab peg rau siab, nruab nrab, thiab qis ISIs

Tom ntej no, txhawm rau txhawm rau txhawm rau txhawm rau txheeb xyuas pab pawg thoob plaws cov neeg mob uas muaj qhov sib txawv ntawm ISI kev faib tawm, ISI rau txhua qhov kev kawm tau raug ntsuas raws li tus qauv ({{0}}) thiab muab faib los ntawm qhov ntev mus rau "tsawg", " nruab nrab," thiab "siab" ISI pawg. Thoob plaws hauv lub subset ntawm cov kev kawm (5/14), rau leej twg ntev ISI preceded ntev qaug dab peg, txhais tau tias qaug dab peg yog 53.1 ± 16.2 vib nas this, 63.19 ± 19.1 vib nas this, thiab 83.4 ± 21.5 vib nas this rau qhov qis, nruab nrab, thiab siab ISI pawg, feem. (Daim duab 3A). Lub sijhawm qaug dab peg tsis txawv txav ntawm pawg ISI (P=0 072, ib-txoj kev ANOVA) (Daim duab 3A). Muab hais tias qhov sib txawv ntawm qhov tshwm sim ntawm kev qaug dab peg ntev yuav tsis tshwm sim los ntawm kev qaug dab peg ib leeg vim nws qhov kev faib tawm tsis sib xws, 6 peb tau nug seb qhov feem pua ​​​​ntawm kev qaug dab peg ntev txawv ntawm ISI pawg. Thoob plaws tib lub subset ntawm cov neeg mob (5/14), qhov sib txawv tseem ceeb ntawm qhov kev faib ua feem ntawm kev qaug dab peg ntev thiab peb pawg ISI tau txheeb xyuas (P < 0.001,="" one-way="" anova).="" pairwise="" hypothesis="" testing="" qhia="" tau="" hais="" tias="" qhov="" feem="" pua="" ​​​​ntawm="" kev="" qaug="" dab="" peg="" ntev="" ntev="" hauv="" pawg="" isi="" qis="" thiab="" nruab="" nrab,="" piv="" rau="" cov="" pab="" pawg="" isi="" siab="" (p=""><0.001; daim="" duab="" 3b).="" qhov="" sib="" txawv="" ntawm="" qhov="" sib="" piv="" ntawm="" kev="" qaug="" dab="" peg="" ntev="" tsis="" yog="" qhov="" tseem="" ceeb="" ntawm="" cov="" isi="" qis="" thiab="" nruab="" nrab="" isi="" pawg="" (p="0.12)." cov="" txiaj="" ntsig="" tau="" muaj="" zog="" rau="" k="2" thiab="" k="4" pawg="" (daim="" duab="">

Hauv kev sib piv, qhov nruab nrab ntawm qhov qaug dab peg thiab qhov kev faib ua feem ntawm kev qaug dab peg ntev rau "tsawg," " nruab nrab," thiab "siab" ISI pawg tau qhia rau tag nrho pawg ntawm 14 yam hauv daim duab 3C-D. Tsis muaj qhov sib txawv tseem ceeb hauv qhov nruab nrab ntawm qhov qaug dab peg (P=0.591) lossis qhov feem ntawm kev qaug dab peg ntev (P=0.064) nyob nruab nrab ntawm peb pawg ISI hauv tag nrho cov qauv. Cov kev tshawb pom no tau lees paub tias kev sib koom ua ke ntawm ISI siab nrog lub sijhawm qaug dab peg ntev dua yog pom tseeb tsuas yog hauv ib pawg ntawm cov ncauj lus.

4 Kev sib tham

Txoj kev tshawb no qhia tau hais tias, nyob rau hauv ib pawg ntawm cov kev kawm, siab ISI yog txuam nrog kev nce ntxiv ntawm kev qaug dab peg ntev. Los ntawm kev siv cov ntaub ntawv tsis ntev los no los ntawm RNS System thiab siv lub sijhawm qaug dab peg raws li tus neeg sawv cev rau kev qaug dab peg, 12,14 cov kev tshawb pom no qhia txog kev soj ntsuam kev soj ntsuam uas ntev ntev ntawm kev qaug dab peg yuav ua rau muaj kev qaug dab peg ntau dua hauv qee tus neeg.

Tsib ntawm kaum plaub qhov kev kawm tau raug txheeb xyuas tias muaj ISI siab uas cuam tshuam rau kev qaug dab peg ntev. Tsis tas li ntawd, qhov kev faib ua feem ntawm kev qaug dab peg ntev tau pom tias yog ib qho kev ntsuas ntau dua thiab nce nrog ISI, piv rau qhov nruab nrab ntawm qhov qaug dab peg. Lwm cov kev tshawb fawb 6,24,26,27 tau siv lwm txoj hauv kev los kawm txog kev sib raug zoo ntawm kev qaug dab peg thiab ntev ISI ua ntej. Kev txhawb nqa ib lub koom haum, stochastic qauv hauv nas27 qhia tau hais tias lub sijhawm qaug dab peg tuaj yeem ua qauv raws li kev ua haujlwm ntawm ISI, uas tau nthuav tawm ntxiv ua haujlwm ntawm lub sijhawm ua ntej qaug dab peg. Ib qho kev sib raug zoo tau pom ntawm lub sijhawm qaug dab peg thiab ISI hauv cov qauv canine, nrog rau ib qho ntawm rau tus dev qhia txog kev sib raug zoo.24 Thaum cov hlau lead thiab pawg qaug dab peg tau pom nyob rau hauv txoj kev tshawb fawb los ntawm Gregg li al, intercluster ISIs tseem yog cov ntsiab lus txuam nrog tsuas yog cov hlau lead. qaug dab peg.

Cook et al tau piav qhia txog qhov nyuaj unimodal lossis bimodal distributions ntawm electrographic qaug dab peg nyob rau hauv tib neeg cov ntaubntawv povthawj siv mus ntev thiab txheeb xyuas ob yam uas short-du ration seizures muaj feem cuam tshuam nrog luv ISI.6 Txoj kev tshawb fawb tam sim no txhawb thiab txhawb nqa cov kev tshawb fawb ua ntej los ntawm kev suav nyiaj rau qaug dab peg. pawg, uas yuav hloov pauv kev txhais lus ntawm ISI zoo heev nrog rau cov xwm txheej ntawm tus kheej. Piv txwv li, yog tias pawg qaug dab peg tsis raug txiav txim siab, qhov kev qaug dab peg ntev ntev tuaj yeem raug ntaus nqi rau luv luv ISI, raws li ntsuas hauv pawg, tsis yog ntsuas qhov tsim nyog tshaj los ntawm pawg ua ntej lossis cais tawm ntawm qhov tam sim no. Tsis tas li ntawd, ib qho intercluster ISI tsuas yog cuam tshuam nrog kev qaug dab peg, tsis yog qhov hnyav kom tsim nyog los txiav txim siab tag nrho pawg qaug dab peg. Yog tsis muaj kev suav nyiaj rau kev qaug dab peg, kev koom tes ntawm ISI thiab lub sijhawm muaj kev xav tau diluted.

Nyob rau hauv sib piv rau yav dhau los kev tshawb fawb, 17 peb tau pom tias lub sij hawm ntev tshaj ntawm qaug dab peg nyob rau hauv ib tug qaug dab peg pawg tshwm sim nyob rau hauv lub variable txoj hauj lwm nyob rau hauv ib pawg, uas yog sib xws nrog cov kev tshawb fawb los ntawm lwm yam kev tshawb fawb siv chronic intracranial recordings.6,24 Vim hais tias ntawm cov kev soj ntsuam, lub sij hawm ntev tshaj plaws. qaug dab peg nyob rau hauv ib pawg, es tsis yog cov hlau lead lossis lub davhlau ya nyob twg, tau siv los sawv cev rau lub sijhawm qaug dab peg rau pawg. Qhov sib txawv ntawm cov kev tshawb pom no piv rau tus kheej-trig ger hypothesis17 yuav cuam tshuam txog qhov sib txawv hauv kev sib koom ua ke lossis ib puag ncig. Ntau dua li qhov chaw thauj mus los, txoj kev tshawb fawb los ntawm Ferastraoaru et al17 tau ua nyob rau hauv ib qho chaw kho mob video-EEG saib xyuas, qhov twg cov tshuaj nquag hloov pauv txhua hnub.

Qhov tshwm sim ntawm kev qaug dab peg ntev tau pom tias yog lwm txoj hauv kev thiab muaj peev xwm ua kom muaj txiaj ntsig zoo dua rau kev qaug dab peg. Qhov kev tshawb pom no txhawb nqa qhov kev tshawb pom ua ntej tias lub sijhawm tsis tau nce ntxiv, 6 vim tias lub sijhawm qaug dab peg tsis zoo sib xws, tab sis feem ntau yog multimodal6 thiab cuam tshuam txog kev qaug dab peg. ntawm tus naj npawb ntawm pawg. Muab hais tias kev qaug dab peg ntev dua yog txuam nrog FBTCS, qhov kev tshawb pom no qhia tias ISI ntev dua tuaj yeem ua rau muaj feem ntawm FBTCS. Thaum lub sij hawm qaug dab peg muab qee qhov kev pom rau hauv hom qaug dab peg, 12,14 lub koom haum ntawm kev qaug dab peg nrog ISI tsis nyob hauv qhov kev kawm thiab yuav txaus siab rau kev ua haujlwm ntxiv. Qhov tseem ceeb, lub ntsiab lus ntawm kev qaug dab peg ntev yog tus neeg mob tshwj xeeb; Raws li pom hauv daim duab S2, lub quintile sab saud tau txhais raws li tus neeg mob. Hauv qhov kev nkag siab no, tus txheeb ze metric hais ncaj qha rau kev soj ntsuam kev soj ntsuam piav qhia los ntawm cov neeg mob, uas paub zoo tshaj plaws ntawm lawv tus kheej qaug dab peg. Txawm hais tias dhau ntawm qhov kev tshawb fawb no, kev tshuaj xyuas qhov sib cuam tshuam ntawm cov neeg mob qhov kev nkag siab ntawm kev qaug dab peg thiab lub sijhawm qaug dab peg tiag tiag, kev soj ntsuam siv cEEG, yuav yog qhov txaus siab rau kev ua haujlwm yav tom ntej. Kev soj ntsuam ntxiv ntawm cov tshuaj phenotypes ntawm cov neeg mob uas muaj kev sib koom ua ke ntawm ISI thiab kev qaug dab peg ntev tsis tau nthuav tawm ib qho kev sib txawv hauv cov pej xeem lossis RNS System yam ntxwv, suav nrog cov khoom siv lead ua lossis hom qaug dab peg.

Lub mechanism (s) hauv qab kev sib raug zoo ntawm ISI thiab qaug dab peg ntev tsis paub tab sis tej zaum yuav cuam tshuam raunco mus ntevCov txheej txheem ntawm cov kab mob vwm.26 Hauv tsiaj thiab tib neeg, qaug dab peg tsis tshwm sim; lawv muaj ib tug nyiam ua pawg nyob rau hauv lub sij hawm 28-31 thiab tawg nyob rau hauv cyclical rhythms, 18,23,32,33 uas implies hais tias tus mob vwm network muaj ib tugkev ncontawm cov xwm txheej ua ntej.23 Kev qaug dab peg thiab pawg neeg muaj feem cuam tshuam nrog lub sijhawm ntev ntawm kev qaug dab peg, 34 ntawm cov uas tau xav tias muaj feem cuam tshuam rau lub sijhawm ntev ntawm kev tawm tsam postictal.35 Tsis txaus postictal inhibition17,36 lossis dhau excitation37 kuj tau cuam tshuam rau hauv pawg qaug dab peg. . Cov mechanisms nyob rau hauv lub inhibitory thiab excitatory tshuav nyiaj li cas uas tsav qaug dab peg lub sij hawm thiab inherentnetwork ncoyog hypothesized los ua lub luag haujlwm ua tau hauv "capacitative effect" pom ntawm no. Tshwj xeeb, nrog rau lub sijhawm ntev ntawm kev qaug dab peg ntawm kev ywj pheej nyob rau hauv ib qho kev hloov pauv tsis sib xws, muaj kev ntxhov siab ntau ntxiv uas cuam tshuam txog kev cuam tshuam waning inhibition tuaj yeem ua rau lub sijhawm ua rau lub network uas txhawb nqa kev qaug dab peg, yog li ua rau lub sijhawm ntawm kev qaug dab peg tom ntej.

Txoj kev tshawb no muaj kev txwv. RNS System tsis yog ib qho khoom siv kaw cia; es, nws siv hluav taws xob stimulation nyob rau hauv teb rau kev tshawb pom ntawm epileptiform kev ua si. Qhov cuam tshuam ntawm qhov nquag stimulation tseem tsis tau paub, tab sis cov teebmeem ntev neuroplasticity yuav muaj tshwm sim.38 Piv txwv li, Yam 6 tau qhia txog kev txo qis hauv kev qaug dab peg yam tsis muaj kev cuam tshuam txog kev coj tus cwj pwm lossis cov tshuaj pharmacological (Daim duab S5), muaj peev xwm cuam tshuam txog cov teebmeem neuromodulatory ntawm cov stimulation ntev. . Yog li ntawd, ntev ISIs feem ntau tshwm sim thaum lub sij hawm tom qab lub sij hawm rau qhov kev kawm no. Qhov siab ISI pab pawg yog li qhov kawg qhia txog lub sijhawm ntawm lub sijhawm thaum qhov kev kawm tau ua tiav kev tswj hwm kev qaug dab peg. Kev txhim kho kev qaug dab peg tuaj yeem cuam tshuam cov ntaub ntawv los ntawm kev ua kom muaj kev nyiam ntawm ISIs siab dua thiab lub sijhawm qaug dab peg.

Lwm qhov kev txwv muaj xws li qhov dav dav ntawm cov kev tshawb pom no. Tshwj xeeb tshaj yog, pawg neeg kawm ntawm no nrog cEEG sawv cev rau pawg neeg xaiv ntawm cov neeg mob uas muaj kev kho mob focal epilepsy. Piv txwv li, cov neeg mob uas muaj tus kabmob kheesxaws tseem ceeb lossis kev tswj hwm kev noj qab haus huv, piv txwv li, tsis suav nrog hauv qhov kev tshawb fawb no, thiab yog li ntawd, qhov kev hloov pauv zoo sib xws tshwm sim hauv cov neeg dav dav ntawm cov neeg mob qaug dab peg tsis tuaj yeem suav tau. Txhawm rau hais txog lwm yam ntawm kev qaug dab peg, xws li kev xav ntawm tus neeg mob, kev tshawb fawb yav tom ntej tuaj yeem tshawb xyuas cov ntawv teev lus hauv hluav taws xob. Nco ntsoov, qhov kev tshawb pom tseem ceeb hauv txoj kev tshawb no - kev sib koom ua ke ntawm ISI siab thiab qhov tshwm sim ntawm kev qaug dab peg ntev nyob rau hauv ib pawg ntawm cov neeg mob - tsis pab kwv yees lub sijhawm ntawm kev qaug dab peg. Hloov chaw, cov kev tshawb pom no ntxiv cov kev siv dag zog txuas ntxiv ntawm kev kwv yees qhov tshwm sim ntawm qaug dab peg, 39,40 los ntawm kev muab cov ntaub ntawv uas yuav pab tau xav txog lwm qhov ntev ntawm kev qaug dab peg.

Tsis tas li ntawd, muaj cov kev txwv tseem ceeb rau kev siv lub sij hawm qaug dab peg raws li tus neeg sawv cev rau kev qaug dab peg, uas muaj ntau lub hom phiaj thiab kev txiav txim siab, suav nrog hom qaug dab peg, zaus, tsis paub, thiab tus neeg mob thiab / lossis cov neeg soj ntsuam percept.2,3,{{ 2}} Ntawm no, electrographic qaug dab peg ntev, lub hom phiaj ntsuas, yog siv los soj ntsuam ib feem ntawm kev qaug dab peg. Cov kev xav ntxiv muaj xws li qhov ua tau tias cov neeg mob tuaj yeem ua rau tsis txaus siab tom qab lub sijhawm ntev ntawm kev qaug dab peg, ua rau kev noj tshuaj tsis ua raws li kev noj haus lossis kev koom tes hauv kev coj cwj pwm uas muaj feem yuav ua rau qaug dab peg ntau dua. Txawm hais tias peb tau tsom mus rau ISI raws li qhov muaj peev xwm kwv yees lub sijhawm qaug dab peg, lwm qhov kev kwv yees muaj peev xwm tsis tau tshuaj xyuas suav nrog lub hauv paus hauv lub xeev ntawm lub network41 thiab cov voj voog ntawm kev ua haujlwm sib cuam tshuam, 18 ob qho tib si cuam tshuam rau qaug dab peg thiab yog li tseem tuaj yeem cuam tshuam rau lub sijhawm qaug dab peg.

Muab hais tias qhov tsis muaj kev cia siab hauv kev mob qaug dab peg cuam tshuam tsis zoo rau lub neej zoo, cov txheej txheem ntawm kev qaug dab peg tom ntej yuav zoo siab kwv yees ob lub sijhawm thiab qhov hnyav ntawm kev qaug dab peg tom ntej. Cov cuab yeej neurostimulation yav tom ntej uas suav nrog cov ntaub ntawv hais txog cov xwm txheej ua ntej tuaj yeem ua kom zoo dua cov lus teb los ntawm kev muab sijhawm sib txawv, kev pheej hmoo-kev kho mob raws li kev kho mob.cov txheej txheem hauv ncoohauv hlwb tes hauj lwm.

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