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HOME > L’RNS RIDUCE LE CONVULSIONI ANCHE NEI BAMBINI
L’RNS RIDUCE LE CONVULSIONI ANCHE NEI BAMBINI
Un gruppo di scienziati del Rutgers Robert Wood Johnson Medical School hanno rilevato che una tecnologia biomedica capace di ridurre in modo importante le convulsioni negli adulti, migliorando nettamente la qualità della vita, può essere applicata anche ai pazienti pediatrici. I risultati della ricerca sono stati pubblicati sulla rivista scientifica Neurosurgery.
Il sistema di neurostimolazione reattivo (RNS) , un trattamento chirurgico comunemente usato per ridurre le crisi epilettiche negli adulti, è efficace e sicuro anche per i bambini, secondo uno studio di Rutgers.
Lo studio è uno dei primi a indagare sul sistema di neurostimolazione reattivo (RNS), un dispositivo simile a un pacemaker che invia cariche elettriche al cuore, che fornisce stimolazione direttamente al cervello quando necessario per prevenire le convulsioni nei bambini.
I risultati della ricerca sono stati pubblicati sulla rivista scientifica Neurosurgery.
RNS e bambini: ecco cosa dice la ricerca
Fino al 40% delle persone che soffrono di crisi epilettiche non risponde ai farmaci. L’RNS, che viene impiantato nel cervello e monitora le onde cerebrali, rileva le convulsioni e l’attività elettrica insolita che può portare a convulsioni, quindi eroga piccoli impulsi di stimolazione per aiutare le onde cerebrali a tornare alla normalità. Il sistema, che non è stato ben studiato nei bambini il cui cervello è ancora in crescita, viene sempre più utilizzato nei centri pediatrici per controllare le convulsioni.
“Mentre espandiamo l’uso dell’RNS ai bambini, è fondamentale considerare come determinare il limite di età inferiore“, ha affermato l’autore principale Yasunori Nagahama, assistente professore di neurochirurgia e direttore della chirurgia dell’epilessia pediatrica presso la Rutgers Robert Wood Johnson Medical School.
“Considerando che questa procedura comporta la rimozione di una porzione del cranio per impiantare il dispositivo, dovrebbero essere considerati i benefici e i potenziali danni basati sullo sviluppo variabile del cranio nei singoli pazienti. I bambini sperimentano una rapida crescita del cranio entro i primi due anni e raggiungono circa il 90% della volume del cranio di un adulto di circa 8 anni. In questo studio, c’erano due pazienti di età inferiore a 7 anni al momento dell’impianto di RNS, incluso un bambino di 3 anni, che era il paziente più giovane segnalato a subire l’impianto di RNS”, ha continuato l’esperto.
I ricercatori hanno esaminato 35 bambini e giovani di età compresa tra 3 e 25 anni con epilessia resistente ai farmaci che sono stati trattati con RNS. Hanno scoperto che l’84 percento ha avuto una riduzione delle convulsioni invalidanti, incluso il 18 percento che ha avuto una riduzione di oltre il 90 percento.
“I risultati suggeriscono che la neurostimolazione reattiva è un efficace trattamento chirurgico off-label dell’epilessia farmacoresistente in pazienti pediatrici accuratamente selezionati“, ha affermato Nagahama: “Tuttavia, sono necessarie ulteriori ricerche sull’efficacia e sulla sicurezza a lungo termine per determinare quali pazienti trarranno maggior beneficio”.
Il dispositivo monitora continuamente l’attività cerebrale e quindi è programmato per rilevare le convulsioni. Quando viene rilevata una crisi o un’attività simile a una crisi, il dispositivo fornisce una piccola quantità di corrente elettrica al cervello per arrestare o abbreviare la crisi, o eventualmente prevenirla del tutto.
I pazienti sono considerati candidati per RNS quando sono stati sottoposti a test diagnostici completi che hanno localizzato uno o due focolai convulsivi, ma sono determinati a non essere candidati alla resezione chirurgica per un motivo particolare. Questi motivi includono convulsioni che hanno origine da più di un’area del cervello, convulsioni che derivano da aree del cervello che non possono essere resecate in sicurezza o convulsioni difficili da localizzare in modo discreto.
L’RNS è un sistema a “circuito chiuso” che monitora continuamente l’attività elettrica del cervello e invia un breve impulso di stimolazione elettrica direttamente al cervello quando viene rilevata una crisi o un’attività simile a una crisi. I medici appositamente formati in RNS programmano il neurostimolatore e lo addestrano gradualmente a rilevare schemi specifici unici per le crisi di un paziente.
La maggior parte dei pazienti ha riportato un miglioramento significativo della qualità della vita con la RNS. È importante tenere presente che la riduzione delle crisi da RNS non è immediata. Potrebbero essere necessari diversi mesi per notare un miglioramento e probabilmente ci vorranno anni per ottenere i risultati ottimali.
L’intervento chirurgico per impiantare il sistema RNS viene eseguito in anestesia generale e richiede in genere tra 2-4 ore. Molti pazienti sono in grado di tornare a casa il giorno successivo e altri possono aspettarsi una degenza ospedaliera di 1-3 giorni. Non è necessario il riposo a letto dopo l’intervento chirurgico e molti pazienti sono in grado di tornare alle proprie attività quotidiane entro pochi giorni e persino al lavoro in 2-4 settimane.
I pazienti che scelgono il trattamento con il sistema RNS giocano un ruolo chiave nella propria cura. Ad ogni paziente viene fornito un monitor remoto, che è essenzialmente un computer portatile, sul quale devono scaricare quotidianamente le informazioni memorizzate sul proprio neurostimolatore. Questo processo richiede solo pochi minuti al giorno.
Una volta alla settimana, viene chiesto loro di caricare i dati archiviati sul loro monitor remoto in un database di un sito Web sicuro dove i loro medici possono esaminarli. Ai pazienti viene dato un magnete e viene chiesto di far scorrere il magnete sul loro neurostimolatore quando hanno un attacco.
Questa azione contrassegna quel particolare evento come importante e il dispositivo memorizza l’attività cerebrale registrata durante quel periodo in modo che il medico possa esaminarlo più da vicino. È anche molto utile per i pazienti tenere un diario dettagliato che annota quando hanno un attacco.
È estremamente importante che il paziente sia disposto e in grado di partecipare agli appuntamenti di follow-up in modo che il dispositivo possa essere programmato secondo necessità per ottenere i migliori risultati. In genere, gli appuntamenti di follow-up sono programmati ogni 4-6 settimane durante il primo anno, ma alla fine diventano meno frequenti.
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Fonte: https://tech.icrewplay.com scritto da DÉNISE MELONI
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