Epilepsy and Deep Brain Stimulation of Anterior Thalamic Nucleus

Perez-Malagon, Carlos D; López-González, Miguel Angel

doi:10.7759/cureus.18199

Cited by 9 publications

(13 citation statements)

References 47 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These findings are consistent with the success seen in the pilot studies of open-loop, chronic DBS targeting the ANT ( Hodaie et al, 2002 ; Kerrigan et al, 2004 ; Andrade et al, 2006 ; Lim et al, 2007 ; Osorio et al, 2007 ; Lee et al, 2012 ). The ANT remain the most widely targeted structure for treating epilepsy with neuromodulation ( Zhong et al, 2011 ; Zangiabadi et al, 2019 ; Perez-Malagon and Lopez-Gonzalez, 2021 ).…”

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Epilepsy, defined as recurring unprovoked seizures, ( Blume et al, 2001 ) is a chronic, debilitating neurologic condition affecting up to 1% of the global population ( Liu et al, 2013 ; Perez-Malagon and Lopez-Gonzalez, 2021 ). While antiepileptic drugs (AED) remain the gold standard of treatment, ( Zhong et al, 2011 ; Yu et al, 2018 ) the World Health Organization estimates one-third of patients do not respond adequately to AEDs; these individuals are considered to have treatment refractory epilepsy (TRE) ( Kwan and Brodie, 2000 ; Liu et al, 2013 ; Perez-Malagon and Lopez-Gonzalez, 2021 ; Velasco et al, 2021 ). The mortality rate for TRE is slightly greater than 1/1,000 person years, ( Perez-Malagon and Lopez-Gonzalez, 2021 ) and advances in neuropharmacology over the last four decades have not significantly improved rates of seizure remission amongst the TRE population ( Chen et al, 2018 ; Sisterson et al, 2019 ).…”

Section: Introductionmentioning

confidence: 99%

“…While antiepileptic drugs (AED) remain the gold standard of treatment, ( Zhong et al, 2011 ; Yu et al, 2018 ) the World Health Organization estimates one-third of patients do not respond adequately to AEDs; these individuals are considered to have treatment refractory epilepsy (TRE) ( Kwan and Brodie, 2000 ; Liu et al, 2013 ; Perez-Malagon and Lopez-Gonzalez, 2021 ; Velasco et al, 2021 ). The mortality rate for TRE is slightly greater than 1/1,000 person years, ( Perez-Malagon and Lopez-Gonzalez, 2021 ) and advances in neuropharmacology over the last four decades have not significantly improved rates of seizure remission amongst the TRE population ( Chen et al, 2018 ; Sisterson et al, 2019 ). While epilepsy surgery is a viable option for patients with an identified epileptogenic focus, ( Yu et al, 2018 ) many individuals are not candidates for resection either because the seizure focus is located in eloquent cortex [motor or speech areas ( Burdette et al, 2021 )], there are multiple foci, or the seizures generalize without an identifiable focus ( Morrell and RNS System in Epilepsy Study Group, 2011 ; Zhong et al, 2011 ).…”

Section: Introductionmentioning

confidence: 99%

“…While epilepsy surgery is a viable option for patients with an identified epileptogenic focus, ( Yu et al, 2018 ) many individuals are not candidates for resection either because the seizure focus is located in eloquent cortex [motor or speech areas ( Burdette et al, 2021 )], there are multiple foci, or the seizures generalize without an identifiable focus ( Morrell and RNS System in Epilepsy Study Group, 2011 ; Zhong et al, 2011 ). Additionally, some patients who are appropriate candidates for surgery may be hesitant to commit to irreversible ablation or resection ( Thomas and Jobst, 2015 ; Perez-Malagon and Lopez-Gonzalez, 2021 ).…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Responsive Thalamic Neurostimulation: A Systematic Review of a Promising Approach for Refractory Epilepsy

Feigen

Eskandar²

2022

Front. Hum. Neurosci.

View full text Add to dashboard Cite

IntroductionResponsive neurostimulation is an evolving therapeutic option for patients with treatment-refractory epilepsy. Open-loop, continuous stimulation of the anterior thalamic nuclei is the only approved modality, yet chronic stimulation rarely induces complete seizure remission and is associated with neuropsychiatric adverse effects. Accounts of off-label responsive stimulation in thalamic nuclei describe significant improvements in patients who have failed multiple drug regimens, vagal nerve stimulation, and other invasive measures. This systematic review surveys the currently available data supporting the use of responsive thalamic neurostimulation in primary and secondary generalized, treatment-refractory epilepsy.Materials and MethodsA systematic review was performed using the following combination of keywords and controlled vocabulary: (“Seizures”[Mesh] AND “Thalamus”[Mesh] AND “Deep Brain Stimulation”[Mesh]) OR (responsive neurostim* AND (thalamus[MeSH])) OR [responsive neurostimulation AND thalamus AND (epilepsy OR seizures)]. In addition, a search of the publications listed under the PubMed “cited by” tab was performed for all publications that passed title/abstract screening in addition to manually searching their reference lists.ResultsTen publications were identified describing a total of 29 subjects with a broad range of epilepsy disorders treated with closed-loop thalamic neurostimulation. The median age of subjects was 31 years old (range 10–65 years). Of the 29 subjects, 15 were stimulated in the anterior, 11 in the centromedian, and 3 in the pulvinar nuclei. Excluding 5 subjects who were treated for 1 month or less, median time on stimulation was 19 months (range 2.4–54 months). Of these subjects, 17/24 experienced greater than or equal to 50%, 11/24 least 75%, and 9/24 at least 90% reduction in seizures. Although a minority of patients did not exhibit significant clinical improvement by follow-up, there was a general trend of increasing treatment efficacy with longer periods on closed-loop thalamic stimulation.ConclusionThe data supporting off-label closed-loop thalamic stimulation for refractory epilepsy is limited to 29 adult and pediatric patients, many of whom experienced significant improvement in seizure duration and frequency. This encouraging progress must be verified in larger studies.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Responsive Thalamic Neurostimulation: A Systematic Review of a Promising Approach for Refractory Epilepsy

Feigen

Eskandar²

2022

Front. Hum. Neurosci.

View full text Add to dashboard Cite

show abstract

Deep brain stimulation (DBS) of thalamus for epilepsy

Fisher¹

2023

Neurostimulation for Epilepsy

View full text Add to dashboard Cite

Strength-frequency curve for micromagnetic neurostimulation through excitatory postsynaptic potentials (EPSPs) on rat hippocampal neurons and numerical modeling of magnetic microcoil (μcoil)

et al. 2022

View full text Add to dashboard Cite

Objective: The objective of this study was to measure the effect of micromagnetic stimulation (μMS) on hippocampal neurons, by using single microcoil (μcoil) prototype, Magnetic Pen (MagPen). MagPen will be used to stimulate the CA3 magnetically and excitatory post synaptic potential (EPSP) measurements will be made from the CA1. The threshold for μMS as a function of stimulation frequency of the current driving the µcoil will be demonstrated. Finally, the optimal stimulation frequency of the current driving the μcoil to minimize power will be estimated. Approach: A biocompatible prototype, MagPen was built, and customized such that it is easy to adjust the orientation of the μcoil over the hippocampal tissue in an in vitro setting. Finite element modeling (FEM) of the μcoil was performed to estimate the spatial profiles of the magnetic flux density (in T) and the induced electric fields (in V/m). The induced electric field profiles generated at different values of current applied to the µcoil whether can elicit a neuron response was validated by numerical modeling. The modeling settings were replicated in experiments on rat hippocampal neurons. Main results: The preferred orientation of MagPen over the Schaffer Collateral fibers was demonstrated such that they elicit a neuron response. The recorded EPSPs from CA1 due to μMS at CA3 were validated by applying tetrodotoxin (TTX). Finally, it was interpreted through numerical analysis that increasing frequency of the current driving the μcoil, led to a decrease in the current amplitude threshold for μMS. Significance: This work reports that μMS can be used to evoke population EPSPs in the CA1 of hippocampus. It demonstrates the strength-frequency curve for µMS and its unique features related to orientation dependence of the µcoils, spatial selectivity and distance dependence. Finally, the challenges related to µMS experiments were studied including ways to overcome them.

show abstract

Epilepsy and Deep Brain Stimulation of Anterior Thalamic Nucleus

Cited by 9 publications

References 47 publications

Responsive Thalamic Neurostimulation: A Systematic Review of a Promising Approach for Refractory Epilepsy

Responsive Thalamic Neurostimulation: A Systematic Review of a Promising Approach for Refractory Epilepsy

Deep brain stimulation (DBS) of thalamus for epilepsy

Strength-frequency curve for micromagnetic neurostimulation through excitatory postsynaptic potentials (EPSPs) on rat hippocampal neurons and numerical modeling of magnetic microcoil (μcoil)

Contact Info

Product

Resources

About