Deep brain stimulation targeting in refractory epilepsy

Cukiert, Arthur; Kai, Li

doi:10.1111/epi.13686

Cited by 59 publications

(51 citation statements)

References 15 publications

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“…Along with the development of research about DBS, the targets of DBS are more diverse and abundant. In addition to the cerebellum, effective sites include hippocampus, subthalamus, hypothalamus, anterior thalamus; caudate, brainstem and seizure focus [26][27][28].…”

Section: Applications Of Dbs For Epilepsymentioning

confidence: 99%

Mechanisms of Deep Brain Stimulation for Epilepsy and Associated Comorbidities

Deng¹,

Luan²

2017

Neuropsychiatry

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Deep brain stimulation (DBS) is an important effective treatment for pharmacoresistant epilepsy, but its mechanism is still not clear. In clinical application, the possible effects and mechanisms DBS in treatment of epilepsy are different according to different stimulation parameters. We reviewed the mechanisms of DBS in different frequencies including high frequency and low frequency in the treatment of epilepsy, covering the inhibition or excitation of synaptic, pathological neuronal and network activity, pathological rhythms or oscillation and neurotransmitter systems. As the onset and progression of seizure, it's more frequent accompanied with cognitive and psychiatric comorbidities in patients with epilepsy. We review the possible mechanism of DBS in treating epilepsy associated comorbidities including cognitive and memory disorders. With the further development of clinical application and basic research of DBS, the processing of clinical individualized therapy of DBS in epilepsy and evaluation of effects of DBS in associated comorbidities may contribute to extend the understanding of the mechanisms of DBS for epilepsy and associated comorbidities.

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Section: Applications Of Dbs For Epilepsymentioning

confidence: 99%

Mechanisms of Deep Brain Stimulation for Epilepsy and Associated Comorbidities

Deng¹,

Luan²

2017

Neuropsychiatry

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“…Current opinion within the epilepsy DBS community is that the CM is not directly visible using structural neuroimaging 10. Instead, presurgical targeting is typically performed indirectly,6 7 9 where a two-dimensional stereotactic atlas of the thalamus, such as the one published by Schaltenbrand and Wahren in the 1970s,11 is superimposed on a CT or MRI scan relative to coarse anatomical landmarks including anterior and posterior commissures.…”

Section: Introductionmentioning

confidence: 99%

Targeting the centromedian thalamic nucleus for deep brain stimulation

Warren

Dalic

Thevathasan

et al. 2020

J Neurol Neurosurg Psychiatry

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ObjectivesDeep brain stimulation (DBS) of the centromedian thalamic nucleus (CM) is an emerging treatment for multiple brain diseases, including the drug-resistant epilepsy Lennox-Gastaut syndrome (LGS). We aimed to improve neurosurgical targeting of the CM by: (1) developing a structural MRI approach for CM visualisation, (2) identifying the CM’s neurophysiological characteristics using microelectrode recordings (MERs) and (3) mapping connectivity from CM-DBS sites using functional MRI (fMRI).Methods19 patients with LGS (mean age=28 years) underwent presurgical 3T MRI using magnetisation-prepared 2 rapid acquisition gradient-echoes (MP2RAGE) and fMRI sequences; 16 patients proceeded to bilateral CM-DBS implantation and intraoperative thalamic MERs. CM visualisation was achieved by highlighting intrathalamic borders on MP2RAGE using Sobel edge detection. Mixed-effects analysis compared two MER features (spike firing rate and background noise) between ventrolateral, CM and parafasicular nuclei. Resting-state fMRI connectivity was assessed using implanted CM-DBS electrode positions as regions of interest.ResultsThe CM appeared as a hyperintense region bordering the comparatively hypointense pulvinar, mediodorsal and parafasicular nuclei. At the group level, reduced spike firing and background noise distinguished CM from the ventrolateral nucleus; however, these trends were not found in 20%–25% of individual MER trajectories. Areas of fMRI connectivity included basal ganglia, brainstem, cerebellum, sensorimotor/premotor and limbic cortex.ConclusionsIn the largest clinical trial of DBS undertaken in patients with LGS to date, we show that accurate targeting of the CM is achievable using 3T MP2RAGE MRI. Intraoperative MERs may provide additional localising features in some cases; however, their utility is limited by interpatient variability. Therapeutic effects of CM-DBS may be mediated via connectivity with brain networks that support diverse arousal, cognitive and sensorimotor processes.

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“…The SANTE (Stimulation of the Anterior Nucleus of the Thalamus for Epilepsy) trial demonstrated statistically significant reductions in seizure frequency in a multicenter prospective randomized cohort of 110 adults with DRE who underwent anterior nucleus DBS. 12 Several DBS targets have been studied, 8 including the anterior thalamic nucleus (ATN) for patients with frontotemporal epilepsy, 21,27,32 the centromedian nucleus of the thalamus (CM) for patients with generalized epilepsy, 40,43,45 and the hippocampus for patients with temporal lobe epilepsy. 4,6 DBS for children is often only considered when patients have reached a treatment-refractory stage of their disease, often with few options remaining.…”

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confidence: 99%

A systematic review of deep brain stimulation for the treatment of drug-resistant epilepsy in childhood

Yan

Toyota

Anderson

et al. 2019

Journal of Neurosurgery: Pediatrics

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OBJECTIVEDrug-resistant epilepsy (DRE) presents a therapeutic challenge in children, necessitating the consideration of multiple treatment options. Although deep brain stimulation (DBS) has been studied in adults with DRE, little evidence is available to guide clinicians regarding the application of this potentially valuable tool in children. Here, the authors present the first systematic review aimed at understanding the safety and efficacy of DBS for DRE in pediatric populations, emphasizing patient selection, device placement and programming, and seizure outcomes.METHODSThe systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and recommendations. Relevant articles were identified from 3 electronic databases (MEDLINE, Embase, and Cochrane CENTRAL) from their inception to November 17, 2017. Inclusion criteria of individual studies were 1) diagnosis of DRE; 2) treatment with DBS; 3) inclusion of at least 1 pediatric patient (age ≤ 18 years); and 4) patient-specific data. Exclusion criteria for the systematic review included 1) missing data for age, DBS target, or seizure freedom; 2) nonhuman subjects; and 3) editorials, abstracts, review articles, and dissertations.RESULTSThis review identified 21 studies and 40 unique pediatric patients (ages 4–18 years) who received DBS treatment for epilepsy. There were 18 patients with electrodes placed in the bilateral or unilateral centromedian nucleus of the thalamus (CM) electrodes, 8 patients with bilateral anterior thalamic nucleus (ATN) electrodes, 5 patients with bilateral and unilateral hippocampal electrodes, 3 patients with bilateral subthalamic nucleus (STN) and 1 patient with unilateral STN electrodes, 2 patients with bilateral posteromedial hypothalamus electrodes, 2 patients with unilateral mammillothalamic tract electrodes, and 1 patient with caudal zona incerta electrode placement. Overall, 5 of the 40 (12.5%) patients had an International League Against Epilepsy class I (i.e., seizure-free) outcome, and 34 of the 40 (85%) patients had seizure reduction with DBS stimulation.CONCLUSIONSDBS is an alternative or adjuvant treatment for children with DRE. Prospective registries and future clinical trials are needed to identify the optimal DBS target, although favorable outcomes are reported with both CM and ATN in children.

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Deep brain stimulation targeting in refractory epilepsy

Cited by 59 publications

References 15 publications

Mechanisms of Deep Brain Stimulation for Epilepsy and Associated Comorbidities

Mechanisms of Deep Brain Stimulation for Epilepsy and Associated Comorbidities

Targeting the centromedian thalamic nucleus for deep brain stimulation

A systematic review of deep brain stimulation for the treatment of drug-resistant epilepsy in childhood

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