Imaging of Anterior Nucleus of Thalamus Using 1.5T MRI for Deep Brain Stimulation Targeting in Refractory Epilepsy

Jiltsova, Elena; Möttönen, Timo; Fahlström, Markus; Haapasalo, Joonas; Tähtinen, Timo; Peltola, Jukka; Öhman, Juha; Larsson, Elna-Marie; Kiekara, Tommi; Kai, Li

doi:10.1111/ner.12468

Cited by 34 publications

(31 citation statements)

References 16 publications

(30 reference statements)

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“…Recent proposed 3T MRI short tau inversion recovery and 1.5T T1 weighted magnetization prepared gradient echo (MPRAGE) images allow for visual delineation of the ANT. The imaging protocols are capable of clearly visualizing the anatomical boundaries of the ANT (mammillothalamic tract and the external medullary lamina) [ 29 , 54 ]. As these imaging protocols were unavailable at the start of SANTE trial, this may provoke uncertainty about the exact location of the active electrodes.…”

Section: Treatment Responsementioning

confidence: 99%

Deep brain stimulation of the anterior nucleus of the thalamus for drug-resistant epilepsy

et al. 2018

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Despite the use of first-choice anti-epileptic drugs and satisfactory seizure outcome rates after resective epilepsy surgery, a considerable percentage of patients do not become seizure free. ANT-DBS may provide for an alternative treatment option in these patients. This literature review discusses the rationale, mechanism of action, clinical efficacy, safety, and tolerability of ANT-DBS in drug-resistant epilepsy patients. A review using systematic methods of the available literature was performed using relevant databases including Medline, Embase, and the Cochrane Library pertaining to the different aspects ANT-DBS. ANT-DBS for drug-resistant epilepsy is a safe, effective and well-tolerated therapy, where a special emphasis must be given to monitoring and neuropsychological assessment of both depression and memory function. Three patterns of seizure control by ANT-DBS are recognized, of which a delayed stimulation effect may account for an improved long-term response rate. ANT-DBS remotely modulates neuronal network excitability through overriding pathological electrical activity, decrease neuronal cell loss, through immune response inhibition or modulation of neuronal energy metabolism. ANT-DBS is an efficacious treatment modality, even when curative procedures or lesser invasive neuromodulative techniques failed. When compared to VNS, ANT-DBS shows slightly superior treatment response, which urges for direct comparative trials. Based on the available evidence ANT-DBS and VNS therapies are currently both superior compared to non-invasive neuromodulation techniques such as t-VNS and rTMS. Additional in-vivo research is necessary in order to gain more insight into the mechanism of action of ANT-DBS in localization-related epilepsy which will allow for treatment optimization. Randomized clinical studies in search of the optimal target in well-defined epilepsy patient populations, will ultimately allow for optimal patient stratification when applying DBS for drug-resistant patients with epilepsy.

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Section: Treatment Responsementioning

confidence: 99%

Deep brain stimulation of the anterior nucleus of the thalamus for drug-resistant epilepsy

et al. 2018

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“…demonstrated the possibility of a precise delineation of the ANT anatomical boundaries using STIR and T1-MPRAGE MR-sequences. [ 15 16 23 33 ] The authors believe that the most important anatomical landmarks in the planning are mammillothalamic tract, the external, and internal medullary lamina. Buentjen L. also indicated the possibility of visualizing ANT anatomical boundaries for direct targeting.…”

Section: Discussionmentioning

confidence: 99%

Bilateral stereotactic lesions and chronic stimulation of the anterior thalamic nuclei for treatment of pharmacoresistant epilepsy

2018

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Background:The use of the anterior nucleus of thalamus (ANT) as a target for treatment of pharmacoresistant epilepsy is based on its crucial role in seizure propagation. We describe results of chronic bilateral ANT stimulation and bilateral ANT lesions in 31 patients with refractory epilepsy.Methods:ANT DBS was performed in 12 patients (group I) and bilateral stereotactic radiofrequency lesions of ANT were performed in 19 patients (group II). Targeting was based on stereotactic atlas information with correction of the final coordinates according to the location of anatomical landmarks and intraoperative microelectrode recording data.Results:Both groups were similar in age, gender, seizures frequency, and duration of disease. The median x, y, and z coordinates of ANT were found to be 2.9, 5, and 11 mm anterior, lateral, and superior to the mid-commissural point, respectively. Mean seizures reduction reached 80.3% in group of patients with ANT DBS with two nonresponders and 91.2% in group of patients with lesions. Five patients from group I and three patients from group II became seizure-free. The morbidity rate was low in both groups.Conclusions:Stereotactic anterior thalamotomy and chronic ANT stimulation are both effective for seizure control in epilepsy originated from frontal and temporal lobes. ANT lesions and stimulation were more effective for secondary-generalized seizures compared to simple partial seizures.

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“…Applied in this study 3Tesla MRI technique is now considered the best visualizing modality allowing clear identification of the boundaries of the sub-cortical grey matter [5]. Urgent interest to subdivisions of the thalamus inspired Bender et al [16] to optimize and modernize protocols trying to enable direct visualization of the main nuclear groups of the thalamus and to improve targeting with coordinates from classic anatomical atlases.…”

Section: Discussionmentioning

confidence: 99%

“…Although the target for non-invasive treatment of such patients was recently shifted to the subthalamic nucleus and the internal globus pallidus [3,4], the wide connections and functional variability of the thalamic nuclei are still under rapt attention of specialists. Thus, the ventro intermediate thalamic nucleus is an approved point for stimulation in case of non-Parkinsonian essential tremor, while the anterior, medial and posterior thalamic regions undergo experimental study now as the functional targets for the relief of the symptoms of epilepsy, schizophrenia, and incessant pain, respectively [5,12].…”

Section: Discussionmentioning

confidence: 99%

“…The interest in the thalamus progressively increased through the last decade due to wide implementation of the "deep brain stimulation" methods of minimally invasive neurosurgical practice [2][3][4][5]. Deep brain stimulation is a powerful method capable of modulating a large variety of neurological symptoms for both movement and psychiatric disorders.…”

Section: Introductionmentioning

confidence: 99%

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Stereotactic Characteristics of the Thalamus Subject to Shape of the Skull: An MRI Study

Kornieieva¹

2017

OARA

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Introduction: The thalamus is a nuclear complex located in the dorsal part of the diencephalon. The wide implementation of deep brain stimulation into minimally invasive neurosurgical practice requires accurate localization of the thalamus. The present study is designed to assess the influence of the individual shape of the skull in relation to the stereotactic characteristics of the thalamus. Materials and methods:A total of 140 Arab patients underwent routine MRI examination of the head. The perpendicular distances from the outer surface of the skull bones to anterior, lateral and superior borders of the thalamus were analyzed in patients with dolichocephalic, mesocephalic, and brachycephalic shapes of the skull. The maximum-likelihood estimation of the observed variables was generalized to the studied population with the method of robust regression. Results:The distance from the anterior end of the thalamus to the outer surface of the frontal bone varies from the 81.92mm in the group of subjects with the dolichocephalic shape of the skull to 77.92mm in the brachiocephalic group, with the middle value obtained in the mesocephalic group. The opposite tendency concerns the distance from the midpoint of the lateral border of the thalamus to the outer surface of the temporal bone. Conclusion:The distances between the counter sides of the thalamus and the outer surfaces of overlaying bones do correlate with the shape of skull, and may contribute to personalization of preoperative stereotactic analysis and approach.

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Imaging of Anterior Nucleus of Thalamus Using 1.5T MRI for Deep Brain Stimulation Targeting in Refractory Epilepsy

Cited by 34 publications

References 16 publications

Deep brain stimulation of the anterior nucleus of the thalamus for drug-resistant epilepsy

Deep brain stimulation of the anterior nucleus of the thalamus for drug-resistant epilepsy

Bilateral stereotactic lesions and chronic stimulation of the anterior thalamic nuclei for treatment of pharmacoresistant epilepsy

Stereotactic Characteristics of the Thalamus Subject to Shape of the Skull: An MRI Study

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