OBJECTIVE To assess based on a single-center data from a multicenter trial (Stimulation of the Anterior Nucleus for the Thalamus for Epilepsy (SANTE)), the role of anatomical connectivity and other factors (e.g., stimulating electrode placement) on efficacy of electro-therapy of the anterior thalamic nuclei (ATN), a node in Papez network, on pharmaco-resistant seizures. DATA SOURCE Adults with at least 6 seizures /month were enrolled in this trial. Percent seizure reduction was compared between subjects with seizures emerging inside Papez's network (IPN) to those with seizures outside it (OPN). Statistical analyses were performed on the first year of the trial. RESULTS Data from 11 subjects were analyzed. At Year 1, median seizure reduction was 80.5% (-100% to -40.3%) in 8/11 subjects with seizures IPN, vs. 52.8% (-61.4% to -23.7%) for 3/11 subjects with seizures OPN (2-sided Wilcoxon p = 0.08). At year 7, 3/11 subjects with seizures IPN had been seizure free for several years vs. 0/11 subjects with seizures OPN. Addition of 4 subjects from a pilot trial with nearly identical protocol to SANTE's, increased to 12/15 the number of subjects with seizures IPN. A 2-sided Fisher's exact test applied to seizure frequency reduction in the 12/15 cohort compared to the 3/15 with seizures OPN, showed significant (p = 0.04) differences in efficacy at the 70% seizure reduction rate. Median quality of life (QOL) scores for subjects with seizures IPN improved by 81% vs. 53% for subjects with seizures OPN. No other factors (e.g., current intensity) had a statistically significant effect on efficacy. CONCLUSIONS Degree of anatomical connectivity between stimulation targets and epileptogenic networks (ENs) plays an important role in therapeutic efficacy. This may be explained by the minimization of signal attenuation inherent in impulse transmission in nervous tissue partly as a function of fiber tract length, tissue anisotropy, and number of synaptic relays between stimulation target and epileptogenic networks.

中文翻译：

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电疗控制癫痫的解剖学连通性和疗效：A SANTE 的单中心回归分析

目的基于多中心试验（癫痫丘脑前核刺激 (SANTE)）的单中心数据，评估解剖学连通性和其他因素（例如，刺激电极放置）对电疗效果的影响。丘脑前核 (ATN)（Papez 网络中的一个节点）对耐药性癫痫发作的治疗。数据来源 本试验招募了至少 6 次/月癫痫发作的成人。在 Papez 网络 (IPN) 内出现癫痫发作的受试者与在其外 (OPN) 出现癫痫发作的受试者之间比较了癫痫发作减少的百分比。在试验的第一年进行了统计分析。结果 分析了 11 名受试者的数据。在第 1 年，8/11 名 IPN 癫痫患者的癫痫发作减少中位数为 80.5%（-100% 至 -40.3%），而 52.8%（-61.4% 至 -23）。7%）对于 3/11 癫痫发作 OPN 受试者（2 侧威尔科克森 p = 0.08）。在第 7 年，3/11 的癫痫 IPN 受试者已经几年没有癫痫发作，而 0/11 的癫痫 OPN 受试者。从与 SANTE 几乎相同的方案的试点试验中添加 4 名受试者，癫痫发作 IPN 的受试者数量增加到 12/15。与癫痫发作 OPN 的 3/15 组相比，应用于 12/15 组癫痫发作频率降低的 2 侧 Fisher 精确检验显示，在 70% 的癫痫发作减少率下，疗效存在显着差异（p = 0.04）。癫痫发作 IPN 受试者的中位生活质量 (QOL) 得分提高了 81%，而癫痫发作 OPN 受试者的生活质量提高了 53%。没有其他因素（例如，电流强度）对疗效有统计学上的显着影响。结论 刺激目标和致癫痫网络 (EN) 之间的解剖连接程度在治疗效果中起着重要作用。这可能是由于神经组织中脉冲传输中固有的信号衰减最小化，部分原因是纤维束长度、组织各向异性和刺激目标和致癫痫网络之间的突触中继数量。