Deep brain stimulation targets in epilepsy: Systematic review and meta‐analysis of anterior and centromedian thalamic nuclei and hippocampus

Vetkas, Artur; Fomenko, Anton; Germann, Jürgen; Sarica, Can; Iorio-Morin, Christian; Samuel, Nardin; Yamamoto, Kazuaki; Milano, Vanessa; Cheyuo, Cletus; Zemmar, Ajmal; Elias, Gavin J B; Boutet, Alexandre; Loh, Aaron; Santyr, Brendan; Gwun, Dave; Tasserie, Jordy; Kalia, Suneil K.; Lozano, Andrés M.

doi:10.1111/epi.17157

Cited by 65 publications

(68 citation statements)

References 83 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…One direction is based on the deep brain stimulation that aims to verify the functional role of the thalamus during the treatment process. Recent studies have confirmed the satisfactory results of thalamic nucleus deep brain stimulation in drug-resistant generalized epilepsy (Fasano et al, 2021;Vetkas et al, 2022). This approach is effective in clinical practice but is invasive.…”

Section: Introductionmentioning

confidence: 84%

Reconfiguration of static and dynamic thalamo-cortical network functional connectivity of epileptic children with generalized tonic-clonic seizures

Wang

et al. 2022

Front. Neurosci.

View full text Add to dashboard Cite

ObjectiveA number of studies in adults and children with generalized tonic-clonic seizure (GTCS) have reported the alterations in morphometry, functional activity, and functional connectivity (FC) in the thalamus. However, the neural mechanisms underlying the alterations in the thalamus of patients with GTCS are not well understood, particularly in children. The aim of the current study was to explore the temporal properties of functional pathways connecting thalamus in children with GTCS.MethodsHere, we recruited 24 children with GTCS and 36 age-matched healthy controls. Static and dynamic FC approaches were used to evaluate alterations in the temporal variability of thalamo-cortical networks in children with GTCS. The dynamic effective connectivity (dEC) method was also used to evaluate the directions of the fluctuations in effective connectivity. In addition, the relationships between the dynamic properties and clinical features were assessed.ResultsThe static FC analysis presented significantly decreased connectivity patterns between the bilateral thalamus and between the thalamus and right inferior temporal gyrus. The dynamic connectivity analysis found decreased FC variability in the thalamo-cortical network of children with epilepsy. Dynamic EC analyses identified increased connectivity variability from the frontal gyrus to the bilateral thalamus, and decreased connectivity variability from the right thalamus to the left thalamus and from the right thalamus to the right superior parietal lobe. In addition, correlation analysis revealed that both static FC and connectivity temporal variability in the thalamo-cortical network related to the clinical features (epilepsy duration and epilepsy onset time).SignificanceOur findings of both increased and decreased connectivity variability in the thalamo-cortical network imply a dynamic restructuring of the functional pathways connecting the thalamus in children with GTCS. These alterations in static and temporal dynamic pathways connecting the bilateral thalamus may extend our understanding of the neural mechanisms underlying the GTCS in children.

show abstract

Section: Introductionmentioning

confidence: 84%

Reconfiguration of static and dynamic thalamo-cortical network functional connectivity of epileptic children with generalized tonic-clonic seizures

Wang

et al. 2022

Front. Neurosci.

View full text Add to dashboard Cite

show abstract

“…It is well known that there is a close connection between epilepsy and psychiatric comorbidities 1 . According to literature, up to 30% of newly diagnosed people with epilepsy and as much as 50% of people with refractory epilepsy experience psychiatric, psychosocial, or cognitive challenges 2–4 . Refractory epilepsy is a condition that affects all sides of life, and it is associated with increased risk of mortality, morbidities, injuries, and sudden unexpected death in epilepsy (SUDEP), as well as unacceptable side effects of antiepileptic medication.…”

Section: Introductionmentioning

confidence: 99%

“…Refractory epilepsy is a condition that affects all sides of life, and it is associated with increased risk of mortality, morbidities, injuries, and sudden unexpected death in epilepsy (SUDEP), as well as unacceptable side effects of antiepileptic medication. In this context, deep brain stimulation (DBS) has become an important tool shown to be one of the most promising neuromodulatory techniques today 3,4 . The SANTE study, 5 the only double‐blinded randomized study for a long time, showed a sustained effect for 2 years of bilateral stimulation to the ANT, and in the open follow‐up continuation after 5 years a 69% reduction of seizure frequency from baseline 6 …”

Section: Introductionmentioning

confidence: 99%

“…1 According to literature, up to 30% of newly diagnosed people with epilepsy and as much as 50% of people with refractory epilepsy experience psychiatric, psychosocial, or cognitive challenges. [2][3][4] Refractory epilepsy is a condition that affects all sides of life, and it is associated with increased risk of mortality, morbidities, injuries, and sudden unexpected death in epilepsy (SUDEP), as well as unacceptable side effects of antiepileptic medication. In this context, deep brain stimulation (DBS) has become an important tool shown to be one of the most promising…”

mentioning

confidence: 99%

See 1 more Smart Citation

ANT‐DBS in epilepsy shows no effect on selected neuropsychiatric tests

Herrman

Osnes

Egge

et al. 2022

Acta Neuro Scandinavica

View full text Add to dashboard Cite

Objectives Deep brain stimulation of the anterior thalamic nucleus (ANT‐DBS) is an established option in treatment‐resistant epilepsy and obtained FDA approval in 2018. Increased psychiatric comorbidity is well known in epilepsy. The main objective of this study was to investigate possible neuropsychiatric treatment‐related changes in patients receiving ANT‐DBS. Materials and Methods Bilateral ANT electrodes were implanted in 18 adult patients with refractory epilepsy in a randomized, double‐blinded study. Immediately after implantation, patients were randomized to stimulation ON (n = 8) or OFF (n = 10) for the first 6 months (blinded phase). During the next six months (open phase), both groups received active stimulation. Neuropsychiatric assessment was conducted before implantation (T1), at the end of the blinded period (T2), and 1 year after implantation (T3). Results Comparing preoperative status (T1) and 12 months (T3), postoperative outcome in all patients did not show significant differences between the two groups for any of the applied tests. Groupwise comparisons across the two first time points (the blinded period, representing the randomized controlled trial) showed no significant differences between the two groups in any of the neuropsychiatric parameters studied. Comparing test results after 6 months of stimulation in both groups (sum of ON group T1 to T2 and OFF group T2 to T3) did not show significant changes for any of the psychiatric assessments. Conclusions Our results indicate that ANT‐DBS has limited effect concerning psychiatric issues. Subjective side effects were, however, reported in individual patients.

show abstract

“…

To the Editor, We read with great interest the systematic review and meta-analysis by Vetkas et al 1 The authors demonstrated different trends of response with different targets of deep brain stimulation (DBS) among patients with drugresistant epilepsy (DRE). While this study provides important clinical insights about DBS use, we have identified a few concerning biases in the study.The meta-analysis included some studies with a low number of patients, as low as three patients.

…”

mentioning

confidence: 99%