NORSE/FIRES中的神经调控。
完整摘要 · 中文译文
神经调控正在成为一种有前景的辅助策略，用于治疗新发难治性癫痫持续状态（NORSE）和发热性感染相关癫痫综合征（FIRES），这些疾病的特点是高发病率、频繁的治疗耐药以及慢性癫痫的显著风险。本章对NORSE/FIRES中已报道的神经调控干预措施进行了系统性综述，包括迷走神经刺激（VNS）、脑深部电刺激（DBS）、反应性神经刺激（RNS）、电惊厥疗法（ECT）和重复经颅磁刺激（rTMS）。在已发表的文献中，VNS是最常报道的技术，且总体耐受性良好，有病例提示其在终止癫痫发作、促进麻醉药物撤除以及长期减少癫痫发作方面具有获益。DBS和RNS主要用于慢性期，并在选择性患者中显示出疗效信号，尽管证据基础仍然有限。ECT在若干病例中与癫痫发作减少或停止相关，尤其是在急性期应用时，但认知不良反应和方案异质性值得注意。rTMS使用较少且效果不一致，但其安全性良好。总体而言，现有证据仅限于病例报告和小型病例系列，无法在不同技术之间进行直接比较或提出明确治疗建议。所有技术均可能存在阳性报告偏倚。尽管如此，神经调控似乎是可行的、总体安全的，并且可能是。 在精心选择的 NORSE/FIRES 患者中是有益的。需要进一步的前瞻性研究来确定最佳时机、刺激参数和患者选择，并阐明急性与慢性神经调控在改善癫痫发作和功能结局方面的相对作用。
完整摘要 · 英文原文
Neuromodulation is emerging as a promising adjunctive strategy for the management of new-onset refractory status epilepticus (NORSE) and febrile infection-related epilepsy syndrome (FIRES), conditions characterized by high morbidity, frequent treatment resistance, and a substantial risk of chronic epilepsy. This chapter presents a systematic review of reported neuromodulation interventions in NORSE/FIRES, including vagus nerve stimulation (VNS), deep brain stimulation (DBS), responsive neurostimulation (RNS), electroconvulsive therapy (ECT), and repetitive transcranial magnetic stimulation (rTMS). Across the published literature, VNS was the most frequently reported technique and was generally well tolerated, with cases suggesting benefit in seizure termination, facilitation of anesthetic withdrawal, and longer-term seizure reduction. DBS and RNS were used predominantly in the chronic phase and showed signals of efficacy in selected patients, although the evidence base remains limited. ECT was associated with seizure reduction or cessation in several cases, particularly when applied in the acute phase, but cognitive adverse effects and heterogeneity of protocols were notable. rTMS was used infrequently and had inconsistent effects, while its safety profile remained favorable. Overall, the available evidence is limited to case reports and small case series, precluding direct comparison between techniques or firm treatment recommendations. Positive reporting bias is likely across all techniques. Nonetheless, neuromodulation appears feasible, generally safe, and potentially beneficial in carefully selected NORSE/FIRES patients. Further prospective studies are needed to define optimal timing, stimulation parameters, and patient selection, and to clarify the relative roles of acute versus chronic neuromodulation in improving both seizure and functional outcomes.