Centromedian thalamic nuclei deep brain stimulation in refractory status epilepticus

Valentı́n, Antonio; Nguyen, Huy Quang; Skupenova, Alena M.; Agirre‐Arrizubieta, Zaloa; Jewell, Sharon; Mullatti, Nandini; Moran, Nicholas; Richardson, Mark P.; Selway, Richard; Alarcón, Gonzalo

doi:10.1016/j.brs.2011.10.002

Cited by 48 publications

(55 citation statements)

References 25 publications

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“…Surgical resection is an alternative, but it is usually fraught with morbidity, as the epileptogenic cortex is often in the vicinity of eloquent cortex. Some techniques related to neuromodulation have been tried for the treatment of EPC and status epilepticus, for instance, vagus nerve stimulation, thalamic deep brain stimulation, and repetitive transcranial magnetic stimulation . In addition, recent studies have shown efficacy using chronic subthreshold cortical stimulation in patients with focal epilepsy from the primary motor cortex …”

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confidence: 99%

Epilepsia partialis continua responsive to neocortical electrical stimulation

et al. 2015

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Epilepsia partialis continua (EPC), defined as a syndrome of continuous focal jerking, is a rare form of focal status epilepticus that usually affects a distal limb, and when prolonged, can produce long-lasting deficits in limb function. Substantial electrophysiologic evidence links the origin of EPC to the motor cortex; thus surgical resection carries the risk of significant handicap. We present two patients with focal, drug-resistant EPC, who were admitted for intracranial video-electroencephalography monitoring to elucidate the location of the epileptogenic focus and identification of eloquent motor cortex with functional mapping. In both cases, the focus resided at or near eloquent motor cortex and therefore precluded resective surgery. Chronic cortical stimulation delivered through subdural strips at the seizure focus (continuous stimulation at 60-130 Hz, 2-3 mA) resulted in >90% reduction in seizures and abolition of the EPC after a follow-up of 22 months in both patients. Following permanent implantation of cortical stimulators, no adverse effects were noted. EPC restarted when intensity was reduced or batteries depleted. Battery replacement restored previous improvement. This two-case report opens up avenues for the treatment of this debilitating condition.

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confidence: 99%

Epilepsia partialis continua responsive to neocortical electrical stimulation

et al. 2015

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“…The remaining 1067 articles were excluded on the basis of not meeting one or both of these criteria. Results of all 41 studies are summarized in Table 1 1-6, 10-13, 15-17,19,20, 23-25,29-40, 42,44,48, 49, 51-57 and the most frequently studied stimulation targets were the ANT (20 studies 1,5, 11, 15, 16, 19, 25,29,30,32,34,37-40, 48, 49, 53-55 ), the CMT (7 studies 10,11,31,44,[51][52][53], and the HCP (10 studies 3,4,11,12,13,20,33,35,36,56 ). It is noteworthy that some articles evaluated multiple targets and are included more than once.…”

Section: Overall Findingsmentioning

confidence: 99%

“…Seven studies over the past decade have investigated the use of CMT DBS for the treatment of epilepsy in 35 patients. 10,11,31,44,[51][52][53] Treatment response rates range from 50% to 100%, depending on the study and the type of epilepsy being treated. The largest series, published by Son et al in 2016, 44 reported a 79% response rate (11 of 14 patients), with a mean seizure frequency reduction of 68%.…”

Section: Centromedian Nucleus Of the Thalamusmentioning

confidence: 99%

“…Two case reports of CMT DBS used in patients with status epilepticus have been published. In 2012, Valentín et al 52 described the successful use of CMT DBS to treat a 27-year-old patient with 5-week history of refractory status epilepticus. Electroencephalography findings were consistent with resolution of status epilepticus on initiation of low-frequency 6-Hz CMT DBS.…”

Section: Centromedian Nucleus Of the Thalamusmentioning

confidence: 99%

“…ported the safety and efficacy of established targets such as the anterior nucleus of the thalamus (ANT), while simultaneously exploring alternative targets such as the centromedian nucleus of the thalamus (CMT), and the hippocampus (HCP). 6,24,25,35,52 This review focuses on studies of clinical outcomes of open-loop DBS published during the last 10 years.…”

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confidence: 99%

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Open-loop deep brain stimulation for the treatment of epilepsy: a systematic review of clinical outcomes over the past decade (2008–present)

Zhou¹,

Chen²,

Farber³

et al. 2018

Neurosurgical Focus

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OBJECTIVEThe field of deep brain stimulation (DBS) for epilepsy has grown tremendously since its inception in the 1970s and 1980s. The goal of this review is to identify and evaluate all studies published on the topic of open-loop DBS for epilepsy over the past decade (2008 to present).METHODSA PubMed search was conducted to identify all articles reporting clinical outcomes of open-loop DBS for the treatment of epilepsy published since January 1, 2008. The following composite search terms were used: (“epilepsy” [MeSH] OR “seizures” [MeSH] OR “kindling, neurologic” [MeSH] OR epilep* OR seizure* OR convuls*) AND (“deep brain stimulation” [MeSH] OR “deep brain stimulation” OR “DBS”) OR (“electric stimulation therapy” [MeSH] OR “electric stimulation therapy” OR “implantable neurostimulators” [MeSH]).RESULTSThe authors identified 41 studies that met the criteria for inclusion. The anterior nucleus of the thalamus, centromedian nucleus of the thalamus, and hippocampus were the most frequently evaluated targets. Among the 41 articles, 19 reported on stimulation of the anterior nucleus of the thalamus, 6 evaluated stimulation of the centromedian nucleus of the thalamus, and 9 evaluated stimulation of the hippocampus. The remaining 7 articles reported on the evaluation of alternative DBS targets, including the posterior hypothalamus, subthalamic nucleus, ventral intermediate nucleus of the thalamus, nucleus accumbens, caudal zone incerta, mammillothalamic tract, and fornix. The authors evaluated each study for overall epilepsy response rates as well as adverse events and other significant, nonepilepsy outcomes.CONCLUSIONSLevel I evidence supports the safety and efficacy of stimulating the anterior nucleus of the thalamus and the hippocampus for the treatment of medically refractory epilepsy. Level III and IV evidence supports stimulation of other targets for epilepsy. Ongoing research into the efficacy, adverse effects, and mechanisms of open-loop DBS continues to expand the knowledge supporting the use of these treatment modalities in patients with refractory epilepsy.

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Responsive neurostimulation for focal motor status epilepticus

Yang

Harid

Nascimento

et al. 2021

Ann Clin Transl Neurol

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No clear evidence-based treatment paradigm currently exists for refractory and super-refractory status epilepticus, which can result in significant mortality and morbidity. While patients are typically treated with antiepileptic drugs and anesthetics, neurosurgical neuromodulation techniques can also be considered. We present a novel case in which responsive neurostimulation was used to effectively treat a patient who had developed super-refractory status epilepticus, later consistent with epilepsia partialis continua, that was refractory to antiepileptic drugs, immunomodulatory therapies, and transcranial magnetic stimulation. This case demonstrates how regional therapy provided by responsive neurostimulation can be effective in treating super-refractory status epilepticus through neuromodulation of seizure networks.

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Centromedian thalamic nuclei deep brain stimulation in refractory status epilepticus

Cited by 48 publications

References 25 publications

Epilepsia partialis continua responsive to neocortical electrical stimulation

Epilepsia partialis continua responsive to neocortical electrical stimulation

Open-loop deep brain stimulation for the treatment of epilepsy: a systematic review of clinical outcomes over the past decade (2008–present)

Responsive neurostimulation for focal motor status epilepticus

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