Physical approaches for the treatment of epilepsy currently under study or development include electrical or magnetic brain stimulators and cooling devices, each of which may be implanted or applied externally. Some devices may stimulate peripheral structures, whereas others may be implanted directly into the brain. Stimulation may be delivered chronically, intermittently, or in response to either manual activation or computer-based detection of events of interest. Physical approaches may therefore ultimately be appropriate for seizure prophylaxis by causing a modification of the underlying substrate, presumably with a reduction in the intrinsic excitability of cerebral structures, or for seizure termination, by interfering with the spontaneous discharge of pathological neuronal networks. Clinical trials of device-based therapies are difficult due to ethical issues surrounding device implantation, problems with blinding, potential carryover effects that may occur in crossover designs if substrate modification occurs, and subject heterogeneity. Unresolved issues in the development of physical treatments include optimization of stimulation parameters, identification of the optimal volume of brain to be stimulated, development of adequate power supplies to stimulate the necessary areas, and a determination that stimulation itself does not promote epileptogenesis or adverse long-term effects on normal brain function.

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评论：治疗癫痫的物理方法：电、磁刺激和冷却。


目前正在研究或开发的治疗癫痫的物理方法包括电或磁脑刺激器和冷却装置，每一种都可以植入或外部应用。一些设备可能会刺激周围结构，而另一些设备可能会直接植入大脑。刺激可以长期地、间歇性地或响应于手动激活或基于计算机的感兴趣事件的检测来传递。因此，物理方法最终可能适合通过引起底层基质的改变（可能会降低大脑结构的内在兴奋性）来预防癫痫发作，或者通过干扰病理神经元网络的自发放电来终止癫痫发作。基于设备的疗法的临床试验很困难，因为围绕设备植入的伦理问题、致盲问题、如果发生基质修改则交叉设计中可能出现的潜在残留效应以及受试者异质性。物理治疗发展中尚未解决的问题包括刺激参数的优化、确定要刺激的最佳大脑体积、开发足够的电源来刺激必要的区域，以及确定刺激本身不会促进癫痫发生或不利的长期癫痫发作。长期对正常大脑功能的影响。