Skip to main content
SpringerLink
Log in
Book cover

Tiefe Hirnstimulation pp 335–340Cite as

Tiefe Hirnstimulation des Nucleus subthalamicus (STN) und der Substantia nigra pars reticulata (SNr) bei der pharmakoresistenten Epilepsie

  • Chapter

  • 152 Accesses

Zusammenfassung

Die Notwendigkeit der Suche nach alternativen Behandlungsmethoden der Epilepsie wird dadurch deutlich, dass trotz wesentlicher pharmakologischer Fortschritte [18] etwa 30% der Patienten, welche an einer Epilepsie leiden, auch unter medikamentöser Behandlung Anfälle haben, die zu einer Behinderung im Alltagsleben führen [23]. Ablative chirurgische Eingriffe mit Entfernung von epileptogenem Hirngewebe sind dann in Betracht zu ziehen, wenn die Anfälle einen fokalen Ursprung haben, und wenn die präoperative Abklärung zeigt, dass die Entfernung des Gewebes nicht mit zusätzlichen und inakzeptablen neurologischen oder kognitiven Defiziten einhergeht [12]. Stimulationsverfahren zur Neuromodulation wurden früher in verschiedenen Hirnregionen eingesetzt: im Cerebellum [7, 31], im Nucleus anterior thalami [8], im Centrum medianum thalami [13, 26], im Nucleus ventralis intermedius thalami (eigene unveröffentlichte Daten), und im Nucleus caudatus [6]. Bekannter wurde die Stimulation des Nervus vagus [15, 25]. Abgesehen von diesen indirekten Zugängen wurde auch vorgeschlagen eine fokale Stimulation der epileptogenen Areale selbst vorzunehmen [27]. Aufgrund experimenteller Untersuchungen gibt es mittlerweile auch genügend Daten, die es rechtfertigen, die chronische Stimulation im nigralen System bzw. im Nucleus subthalamicus beim Menschen zu untersuchen.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   54.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Literatur

  1. Albin R, Young A, Penney J (1989) The functional anatomy of basal ganglia in movement disorders. TINS 12:366–375

    PubMed  CAS  Google Scholar 

  2. Benabid AL, Pollak P, Gervason C et al. (1991) Long-term suppression of tremor by chronic stimulation of the ventral intermediate thalamic nucleus. Lancet 337:403–406

    Article  PubMed  CAS  Google Scholar 

  3. Benazzouz A, Gross C, Feger J, Boraud T, Bioulac B (1993) Reversal of rigidity and improvement in motor performance by subthalamic high-frequency stimulation in MPTP-treated monkeys. Eur J Neurosci 5:382–389

    Article  PubMed  CAS  Google Scholar 

  4. Benazzouz A, Piallat B, Pollak P, Benabid AL (1995) Responses of substantia nigra pars reticulata and globus pallidus complex to high frequency stimulation of the subthalamic nucleus in rats: electrophysiological data. Neurosci Lett 189:77–80

    Article  PubMed  CAS  Google Scholar 

  5. Bressand K, Dematteis M, Kahane P, Benazzouz A, Benabid AL (1999) Involvement of the subthalamic nucleus in the control of temporal lobe epilepsy: study by high frequency stimulation in rats. Abstract # 663.3, 29th Annual Meeting of the Society for Neuroscience, Miami (USA), 23–28 October

    Google Scholar 

  6. Chkhenkeli SA, Chkhenkeli IS (1997) Effects of therapeutic stimulation of nucleus caudatus on epileptic electrical activity of brain in patients with intractable epilepsy. Stereotact Funct Neurosurg 69:221–224

    Article  PubMed  CAS  Google Scholar 

  7. Cooper IS, Upton AR (1978) Use of chronic cerebellar stimulation for disorders of disinhibition. Lancet 1:595–600

    Article  PubMed  CAS  Google Scholar 

  8. Cooper IS, Upton AR, Amin I (1980) Reversibility of chronic neurologic deficits. Some effects of electrical stimulation of the thalamus and internal capsule in man. Appl Neurophysiol 43:244–258

    PubMed  CAS  Google Scholar 

  9. Deransart C, Marescaux C, Depaulis A (1996) Involvement of nigral glutamatergic inputs in the control of seizures in a genetic model of absence epilepsy in the rat. Neuroscience 71:721–728

    Article  PubMed  CAS  Google Scholar 

  10. Depaulis A, Vergnes M, Depaulis A (1994) Endogenous control of epilepsy: the nigral inhibitory system. Prog Neurobiol 42:33–52

    Article  PubMed  CAS  Google Scholar 

  11. Dybdal D, Gale K (1996) Anticonvulsant effects of focal inhibition of the subthalamic nucleus. 26th Annual Meeting of the American Epilepsy Society, San Francisco, California; december 7-10 (abstract)

    Google Scholar 

  12. Engel J Jr (1996) Surgery for seizures. N Engl J Med 334:647–652

    Article  PubMed  Google Scholar 

  13. Fisher RS, Uematsu S, Krauss GL et al. (1992) Placebo-controlled pilot study of centromedian thalamic stimulation in treatment of tntractable seizures. Epilepsia 33:841–851

    Article  PubMed  CAS  Google Scholar 

  14. Gale K (1985) Mechanisms of seizure control mediated by gamma-aminobutyric acid: role of the substantia nigra. Fed Proc 44:2414–2424

    PubMed  CAS  Google Scholar 

  15. Handforth A, Di Giorgio CM, Schlackter SC et al. (1998) Vagus nerve stimulation therapy for partial onset seizures: a randomized active-control trial. Neurology 51:48–55

    Article  PubMed  CAS  Google Scholar 

  16. Iadarola MJ, Gale K (1982) Substantia nigra: site of anticonvulsant activity mediated by gammaaminobutyric acid. Science 218:1237–1240

    Article  PubMed  CAS  Google Scholar 

  17. Krack P, Pollak P, Limousin P et al. (1998) Opposite motor effects of pallidal stimulation in Parkinson’s disease. Ann Neurol 43:180–192

    Article  PubMed  CAS  Google Scholar 

  18. Kwan P, Brodie M (2000) Early identification of refractory epilepsy. N Engl J Med 342:314–319

    Article  PubMed  CAS  Google Scholar 

  19. Limousin P, Pollak P, Benazzouz A et al. (1995) Effect on parkinsonian signs and symptoms of bilateral subthalamic nucleus stimulation. Lancet 345:91–95

    Article  PubMed  CAS  Google Scholar 

  20. Limousin P, Krack P, Pollak P et al. (1998) Electrical stimulation of the subthalamic nucleus in advanced Parkinson’s disease. N Engl J Med 339(16):1105–111

    Article  PubMed  CAS  Google Scholar 

  21. Mondragon S, Lamarche M (1990) Suppression of motor seizures after specific thalamothomy in chronic epileptic monkeys. Epilepsy Res 5:137–145

    Article  PubMed  CAS  Google Scholar 

  22. Pollak P, Benabid AL, Gross C et al. (1993) Effets de la stimulation du noyau sous-thalamique dans la maladie de Parkinson. Rev Neurol 149:175–176

    PubMed  CAS  Google Scholar 

  23. Sander JWAS (1993) Some aspects of prognosis in the epilepsies: a review. Epilepsia 34:1007–1016

    Article  PubMed  CAS  Google Scholar 

  24. Siegfried J, Lippitz B (1994) Bilateral chronic electro stimulation of ventroposterolateral pallidum: a new therapeutic approach for alleviating all parkinsonian symptoms. J Neurosurg 35:1126–1130

    Article  CAS  Google Scholar 

  25. The vagus nerve stimulation study group (1995) A randomized controlled trial of chronic vagus nerve stimulation for treatment of medically intractable seizures. Neurology 45:224–230

    Article  Google Scholar 

  26. Velasco F, Velasco M, Velasco AL, Jimenez F, Marquez I, Rise M (1995) Electrical stimulation of the centromedian thalamic nucleus in control of seizures: long-term studies. Epilepsia 36:63–71

    Article  PubMed  CAS  Google Scholar 

  27. Velasco M, Velasco F, Velasco AL et al. (2000) Subacute electrical stimulation of the hippocampus blocks intractable temporal lobe seizures and paroxysmal EEG activities. Epilepsia 41:158–169

    Article  PubMed  CAS  Google Scholar 

  28. Veliskova J, Velsek L, Moshe SL (1996) Subthalamic nucleus: a new anticonvulsant site in the brain. Neuroreport 7:1786–1788

    Article  PubMed  CAS  Google Scholar 

  29. Vercueil L, Benazzouz A, Deransart C et al. (1998) High frequency stimulation of the sub-thalamic nucleus suppresses absence seizures in the rat: comparison with neurotoxic lesions. Epilepsy Res 31:39–46

    Article  PubMed  CAS  Google Scholar 

  30. Wiebe S, Blume WT, Girvin JP, Eliasziw M (2001) A randomized, controlled trial of surgery for temporal-lobe epilepsy. N Engl J Med 345:311–318

    Article  PubMed  CAS  Google Scholar 

  31. Wright GD, McClellan DL, Brice JGA (1984) A double-blind trial of chronic cerebellar stimulation in twelve patients with epilepsy. J Neurol Neurosurg Psychiatry 47:769–774

    Article  PubMed  CAS  Google Scholar 

Download references

Authors
  1. A. L. Benabid
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Koudsie
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. Chabardes
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. L. Vercueil
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A. Benazzouz
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. L. Minotti
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. J.-F. Le Bas
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. P. Kahane
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. A. De Saint Martin
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. E. Hirsch
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Neurochirurgische Klinik, Universitätsklinikum Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany

    Joachim K. Krauss

  2. Neurologische Klinik, Universitätsklinikum Schleswig-Holstein - Campus Kiel, Schittenhelmstraße 10, 24105, Kiel, Germany

    Jens Volkmann

Rights and permissions

Reprints and permissions

Copyright information

© 2004 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Benabid, A.L. et al. (2004). Tiefe Hirnstimulation des Nucleus subthalamicus (STN) und der Substantia nigra pars reticulata (SNr) bei der pharmakoresistenten Epilepsie. In: Krauss, J.K., Volkmann, J. (eds) Tiefe Hirnstimulation. Steinkopff, Heidelberg. https://doi.org/10.1007/978-3-7985-1956-5_20

Download citation

  • DOI: https://doi.org/10.1007/978-3-7985-1956-5_20

  • Publisher Name: Steinkopff, Heidelberg

  • Print ISBN: 978-3-642-62359-2

  • Online ISBN: 978-3-7985-1956-5

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation