Clinical Outcome of Patients with Deep Brain Stimulation of the Centromedian Thalamic Nucleus for Refractory Epilepsy and Location of the Active Contacts

Abstract

Objectives: To investigate the clinical outcome of patients treated with chronic deep brain stimulation (DBS) of the centromedian nucleus (CM) for refractory epilepsy and to determine the location of active contacts. Methods: The outcome of CM stimulation was evaluated as percent seizure reduction compared to the baseline 3 months. To establish the location of active contacts, 27 leads were studied in 14 patients with refractory epilepsy. An analysis was conducted to reveal whether any coordinates of the center of the active contacts predicted percent seizure reduction. Results: With an average follow-up of 18.2 ± 5.6 months, the mean percent seizure reduction (n = 14) was 68 ± 22.4% (25-100%). Eleven of the 14 patients (78.6%) achieved >50% improvement in seizure frequency. Specifically, all 4 patients (100%) with generalized epilepsy (Lennox-Gastaut syndrome) and 7 of 10 patients (70%) with multilobar epilepsy showed >50% reduction in seizure frequency. The mean coordinates of the center of the active contact were located in the superior part of the anterior ventrolateral CM. The calculated coordinates of laterality from midline (x), anterior-posterior (y) and height (z) from the posterior commissure did not correlate with seizure outcome measured by percent seizure reduction. However, the locations of active contacts used during chronic CM stimulation in multilobar epilepsy were identified more dorsal to those used in generalized epilepsy. Conclusions: Chronic CM stimulation is a safe and effective means in the treatment of refractory epilepsy.

Effect of neurostimulation on cognition and mood in refractory epilepsy

“…Velasco et al investigated the effect of stimulating the centromedian nucleus for treating generalized seizures in 13 patients with Lennox‐Gastaut syndrome and found that the overall seizure reduction was 80% at 18 months. Similarly, Son et al found that centromedian thalamic nuclei stimulation effectively reduced seizures in 11 of 14 patients, including 100% of those with Lennox‐Gastaut syndrome.…”

Relationship between Postoperative EEG Driving Response and Lead Location in Deep Brain Stimulation of the Anterior Nucleus of the Thalamus for Refractory Epilepsy

“…However, it was not elicited in the most proximal electrode contact landing outside the thalamic tissue, within the lateral ventricle, as verified by postoperative MRI in 2 patients in whom the electrodes did not extend more deeply than the calculated border of the anterior nucleus [6]. Although elicitation of DR was an essential observation in the SANTE trial [2], DR and an intraoperative EEG study, such as single pulse electrical stimulation through the electrode contacts, are regarded as an essential step to verify the final electrode position in some centers [9,19,20]. …”

Deep brain stimulation for seizure control in drug-resistant epilepsy

“…Many structures have been the target of stimulation in human trials to improve seizure control ( Fig. 1 and Table 1), including the ANT, 2,20,39,57,66 the centromedian nucleus of the thalamus (CMT), 21,52,60,64,67 the cerebellum, 4,65,69,75 the hippocampus, 5,7,14,15,30,68,73 and the subthalamic nucleus (STN). 10,26,36,71 Common DBS Targets…”