Anticonvulsive effect of anterior thalamic deep brain stimulation in super-refractory status epilepticus crucially depends on active stimulation zone—A single case observation

Low frequency centromedian thalamic nuclei deep brain stimulation for the treatment of super refractory status epilepticus: A case report and a review of the literature

“…The timing of DBS implantation after srSE onset is variable (28e59 days) and the ideal DBS target for srSE has not been established. In three cases, the DBS was implanted at the anterior nucleus of the thalamus for absence srSE [3], convulsive srSE [4] and non-convulsive rSE [5]. In four cases, the CMN was targeted either due to common variable immunodeficiencyassociated encephalomyelitis [6], possible encephalitis (autoimmune/infectious) complicated with cardiac arrest [7], or febrile infection-related epilepsy syndrome (FIRES) [8].…”

“…There is a lack of consensus regarding the best DBS parameters. High-frequency stimulation (130Hz [4,8] , 145Hz [3,5], or 180Hz [6], with a 70e90 ms pulse width) appeared to be effective in the treatment of generalised seizures, successfully resolving the srSE (Table 1). Occasionally, the improvement in frequency of generalised seizures evolves to frequent focal or multifocal seizures.…”

Responsive neurostimulation for focal motor status epilepticus

“…As reviewed by other authors, 14,19 deep brain stimulation (DBS), RNS, and vagal nerve stimulation (VNS) have been used as management options for RSE. In few case reports, DBS of the zona incerta, 20 CM nucleus, [21][22][23] and the anterior nucleus [24][25][26] has been used to stop RSE. Cortical stimulation using an adapted DBS device has also been reported in the literature for EPC, though it was not reported whether maximal medical treatment was attempted.…”

The medial pulvinar as a subcortical relay in temporal lobe status epilepticus

“…Furthermore, the activation of the PuM during temporal lobe seizures was demonstrated through invasive EEG recordings [6] and recently high frequency stimulation in the PuM showed active inhibition of temporal lobe seizures [7]. Similarly, other studies showed that also anterior or centro-median thalamic deep brain stimulation (DBS) can modulate ongoing ictal activity through inhibition of key nodes within the epileptic network [8,9]. These findings suggest that variable cortical projections of different thalamic relay nuclei, modulate the epileptic network in SE.…”