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ESTIMULACION DEL SISTEMA NERVIOSO PARA EL CONTROL DE LA EPILEPSIA REFRACTARIA

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ESTIMULACION DEL SISTEMA NERVIOSO PARA EL CONTROL DE LA EPILEPSIA REFRACTARIA

(especial para SIIC © Derechos reservados)
Se puede considerar el empleo de la estimulación del nervio vago en pacientes que presentan epilepsia refractaria a tres o más drogas anticonvulsivas.
murphy9.jpg Autor:
Jerome Murphy
Columnista Experto de SIIC

Institución:
Children's Mercy Hospital

Artículos publicados por Jerome Murphy
Coautor
Arun Angelo Patil* 
Professor of Neurosurgery. University of Nebraska Medical Center*
Recepción del artículo
20 de Mayo, 2005 		Aprobación
30 de Mayo, 2005
Primera edición
18 de Abril, 2006 		Segunda edición, ampliada y corregida
7 de Junio, 2021

ESTIMULACION DEL SISTEMA NERVIOSO PARA EL CONTROL DE LA EPILEPSIA REFRACTARIA

Resumen
La estimulación del nervio vago (ENV), una estimulación indirecta del cerebro, demostró ser efectiva en modelos de epilepsia con animales y, posteriormente, en un estudio de tipo abierto y en ensayos a doble ciego con más de 450 pacientes. El beneficio, valorado por la disminución en el número de episodios convulsivos, se mantuvo por al menos un año y medio; aproximadamente el 50% de los pacientes tratados logró una reducción de casi el 50% en la frecuencia de las convulsiones. Otros beneficios fueron: la terminación de las convulsiones y la mejoría en el estado de ánimo. Los beneficios se demostraron en niños y adultos con epilepsias generalizadas y parciales y en síndromes epilépticos específicos. El procedimiento de implante es sencillo. El mecanismo de acción es desconocido, aunque la ENV parece alterar la actividad metabólica en núcleos cerebrales específicos. La mejoría en el estado de ánimo llevó a que su uso fuese aprobado en pacientes con depresión grave. La estimulación cerebral profunda (ECP) está en investigación como método alternativo para el control de las convulsiones refractarias a la medicación. Se basa en que la estimulación talámica puede influir sobre el EEG en un área extensa. Diversos núcleos talámicos, así como el complejo amígdala-hipocampo, el núcleo caudado y la sustancia negra fueron objeto de la estimulación, con resultados promisorios en el tratamiento de la epilepsia refractaria al tratamiento médico. El procedimiento se realiza bajo anestesia local y es esencial la obtención de imágenes cerebrales intraoperatorias. La experiencia con la ECP es limitada, pero creciente.

Palabras clave
Epilepsia refractaria, estimulación del nervio vago, estimulación de las capas cerebrales más profundas


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STIMULATING THE NERVOUS SYSTEM TO CONTROL REFRACTORY EPILEPSY

Abstract
Vagal nerve stimulation (VNS), an indirect stimulation of the brain, proved effective in animal models of epilepsy, and then in open, as well as double-blinded trials, in over 450 patients. The benefit, seizure reduction, improved for at least 1 1/2 years with almost 50% of treated patients achieving about a 50% reduction in seizure frequency. Other benefits are: seizure termination and improved mood. Benefits have been shown in children and adults with partial and generalized epilepsies, and in specific epilepsy syndromes. Implantation is easy. The method of action is largely unknown, although VNS appears to alter metabolic activity in specific brain nuclei. The improvement in mood has lead to its approved use in patients with severe depression. Deep brain stimulation (DBS) is under investigation as an alternate method for controlling medically refractory seizures. It is based on the observation that thalamic stimulation can influence the EEG over a wide area. Several thalamic nuclei, as well as the amygdalahippocampus complex, caudate nucleus, and substantia nigra, have been the object of stimulation, all holding promise in the treatment of medically refractory epilepsy. Intraoperative brain imaging is essential and the procedure is done under local anesthesia. Experience with DBS is limited, but growing.

Key words
Vagal nerve stimulation, refractory epilepsy, deep brain stimulation


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Patrocinio y reconocimiento:
Agradecimiento: El Dr. Murphy recibió apoyo para la investigación, honorarios y reembolsos del consejo asesor de Cyberonics, fabricante del equipamiento utilizado en estimulación del nervio vago.
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