Chronic deep brain stimulation in mesial temporal lobe epilepsy

Boëx, Colette; Seeck, Margitta; Vulliémoz, Serge; Rossetti, Andrea O.; Staedler, Claudio; Spinelli, Laurent; Pegna, Alan J.; Pralong, Étienne; Villemure, Jean‐Guy; Foletti, G.; Pollo, Claudio

doi:10.1016/j.seizure.2011.03.001

Cited by 108 publications

(89 citation statements)

References 29 publications

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“…Dose, mode of administration, and the resulting site of action may be critical determinants of ketamine's conflicting effects on seizure activity. Consistent with the present findings, however, ketamine has been reported to increase gamma oscillations in rat hippocampus (Caixeta et al 2013). The spectral content of ictal events was similar to seizures observed in human TLE (see Fig.…”

Section: Discussionsupporting

confidence: 92%

Sensing-enabled hippocampal deep brain stimulation in idiopathic nonhuman primate epilepsy

Lipski

DeStefino

Stanslaski

et al. 2015

Journal of Neurophysiology

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-Epilepsy is a debilitating condition affecting 1% of the population worldwide. Medications fail to control seizures in at least 30% of patients, and deep brain stimulation (DBS) is a promising alternative treatment. A modified clinical DBS hardware platform was recently described (PCϩS) allowing long-term recording of electrical brain activity such that effects of DBS on neural networks can be examined. This study reports the first use of this device to characterize idiopathic epilepsy and assess the effects of stimulation in a nonhuman primate (NHP). Clinical DBS electrodes were implanted in the hippocampus of an epileptic NHP bilaterally, and baseline local field potential (LFP) recordings were collected for seizure characterization with the PCϩS. Real-time automatic detection of ictal events was demonstrated and validated by concurrent visual observation of seizure behavior. Seizures consisted of large-amplitude 8-to 25-Hz oscillations originating from the right hemisphere and quickly generalizing, with an average occurrence of 0.71 Ϯ 0.15 seizures/day. Various stimulation parameters resulted in suppression of LFP activity or in seizure induction during stimulation under ketamine anesthesia. Chronic stimulation in the awake animal was studied to evaluate how seizure activity was affected by stimulation configurations that suppressed broadband LFPs in acute experiments. This is the first electrophysiological characterization of epilepsy using a next-generation clinical DBS system that offers the ability to record and analyze neural signals from a chronically implanted stimulating electrode. These results will direct further development of this technology and ultimately provide insight into therapeutic mechanisms of DBS for epilepsy. deep brain stimulation; hippocampus; temporal lobe epilepsy; local field potential EPILEPSY IS A COLLECTION of diverse disorders, varying in pathogenesis, site of seizure onset, and response to treatment. Temporal lobe epilepsy (TLE) is a common form of the disorder, characterized by seizures originating in the temporal lobe, most frequently in the hippocampus and amygdala. In cases where pharmacological therapy either fails to adequately control seizures or is not well tolerated, resective surgery is an effective treatment, suppressing disabling seizures in 50 -80% of patients undergoing mesial TLE (MTLE) resections (Engel et al. 2003). Seizure freedom occurs in fewer than 50% of patients undergoing extratemporal resections (de Tisi et al. 2011), however, and resective surgery is not an option for cases where the seizure focus is not well localized or when resection would cause unacceptable functional deficits. These problems, coupled with the nonreversible nature of resective surgery, underscore the need for new and more effective alternative treatments for medically refractory epilepsy. Deep brain stimulation (DBS) is a promising emerging therapy for focal epilepsy. Most efforts to date have focused on modulating nodes within the limbic circuit of Papez, a network often implica...

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Section: Discussionsupporting

confidence: 92%

Sensing-enabled hippocampal deep brain stimulation in idiopathic nonhuman primate epilepsy

Lipski

DeStefino

Stanslaski

et al. 2015

Journal of Neurophysiology

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“…In contrast, cDES studies typically report no effect of hippocampal stimulation on memory although this is likely explained by the fact that stimulation does not occur specifically during encoding (Boëx et al, 2011;McLachlan, Pigott, Tellez-Zenteno, Wiebe, & Parrent, 2010;Miatton et al, 2011;Velasco et al, 2007). In these studies, high frequency (130 -450Hz) direct electrical stimulation was delivered chronically (3 to 18 months) to the hippocampal region, and patients were tested using standardized memory tasks in the baseline state (before stimulation or with stimulation off for a matched period of time) vs. after chronic stimulation.…”

Section: Hippocampal Stimulationmentioning

confidence: 96%

A network approach for modulating memory processes via direct and indirect brain stimulation: Toward a causal approach for the neural basis of memory

Kim¹,

Ekstrom

Tandon³

2016

Neurobiology of Learning and Memory

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A network approach for modulating memory processes via direct and indirect brain stimulation: Toward a causal approach for the neural basis of memory This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. that disrupting frontal or parietal regions also impairs memory performance, suggesting that these regions also play necessary roles in declarative memory. On the other hand, a handful of both invasive and non-invasive studies have also suggested modest improvements in memory performance following stimulation. These studies typically target brain regions connected to the hippocampus or other memory "hubs," which may affect endogenous activity in connected areas like the hippocampus, suggesting that to augment declarative memory, altering the broader endogenous memory network activity is critical. Together, studies reporting memory improvements / impairments are consistent with the idea that a network of distinct brain "hubs" may be crucial for successful memory encoding and retrieval rather than a single primary hub such as the hippocampus. Thus, it is important to consider neurostimulation from the network perspective, rather than from a purely localizationalist viewpoint. We conclude by proposing a novel approach to neurostimulation for declarative memory modulation that aims to facilitate interactions between multiple brain "nodes" underlying memory rather than considering individual brain regions in isolation.

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“…Two small series of hippocampal stimulation have been reported by the University of Western Ontario group [65,66]. In the first, 4 patients with left mesial temporal seizure onset who were unable to undergo resection (1 owing to prior right temporal resection, 3 owing to failed intracarotid amobarbital testing) underwent placement of unilateral quadripolar electrodes (3 mm contacts, 6 mm spacing; total span 30 mm) with the first contact in the pes hippocampus and 3 contacts in the hippocampal body.…”

Section: Hippocampal Formationmentioning

confidence: 99%

“…More recently, the Swiss group of Boëx et al [66] presented a series of 8 TLE patients (2 with HS, 6 nonlesional) who were unable to undergo amygdalohippocampectomy owing to bilateral onset (5 patients) or onset ipsilateral to preserved verbal memory (3 patients). All patients received unilateral DBS placement on the side of more frequent seizure onset as determined noninvasively (3 patients) or with intracranial recording (5 patients).…”

Section: Hippocampal Formationmentioning

confidence: 99%

Deep Brain Stimulation for the Treatment of Epilepsy: Circuits, Targets, and Trials

2014

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Deep brain stimulation (DBS) has proven remarkably safe and effective in the treatment of movement disorders. As a result, it is being increasingly applied to a range of neurologic and psychiatric disorders, including medically refractory epilepsy. This review will examine the use of DBS in epilepsy, including known targets, mechanisms of neuromodulation and seizure control, published clinical evidence, and novel technologies. Cortical and deep neuromodulation for epilepsy has a long experimental history, but only recently have better understanding of epileptogenic networks, precise stereotactic techniques, and rigorous trial design combined to improve the quality of available evidence and make DBS a viable treatment option. Nonetheless, underlying mechanisms, anatomical targets, and stimulation parameters remain areas of active investigation.

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Chronic deep brain stimulation in mesial temporal lobe epilepsy

Cited by 108 publications

References 29 publications

Sensing-enabled hippocampal deep brain stimulation in idiopathic nonhuman primate epilepsy

Sensing-enabled hippocampal deep brain stimulation in idiopathic nonhuman primate epilepsy

A network approach for modulating memory processes via direct and indirect brain stimulation: Toward a causal approach for the neural basis of memory

Deep Brain Stimulation for the Treatment of Epilepsy: Circuits, Targets, and Trials

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