Precision mapping of the epileptogenic network with low- and high-frequency stimulation of anterior nucleus of thalamus

Chaitanya, Ganne; Tóth, Emília; Pizarro, Diana; Irannejad, Auriana; Riley, Kristen; Pati, Sandipan

doi:10.1016/j.clinph.2020.05.036

Cited by 21 publications

(26 citation statements)

References 32 publications

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“…There was no correlation between volumes of thalamic nuclei and ITPC . A role of subcortical nuclei in the generation of synchronous gamma activity is certain ( Chaitanya et al., 2020 ). For instance, patients with small subcortical stroke lesions show a widespread impairment of generation of gamma activity in phase ( Pellegrino et al., 2019a ).…”

Section: Discussionmentioning

confidence: 99%

“…Animal models revealed that auditory-driven gamma synchrony involves all cortical layers, with maximum synchrony in the granular layer (layer 4 or thalamo-recipient layers) ( Li et al., 2021 ). Subcortical regions are part of a large thalamo-cortical reverberant circuit and the thalamus acts as a pulse generator with its projections to the granular cortex (layer 4) ( Chaitanya et al., 2020 ). Thalamic projections are mostly excitatory, but whether the net effect of thalamic activity is an enhancement of cortical synchrony is still unclear.…”

Section: Introductionmentioning

confidence: 99%

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Auditory driven gamma synchrony is associated with cortical thickness in widespread cortical areas

et al. 2022

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Auditory driven gamma synchrony is associated with cortical thickness in widespread cortical areas

et al. 2022

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“…The emergence of sEEG has facilitated simultaneous neocortical and thalamic recording during standard epilepsy surgery evaluation 11 . This approach has demonstrated medial pulvinar reflection of temporal lobe seizures, suggesting that the pulvinar is involved in pathways of seizure propagation 12 .…”

Section: Discussionmentioning

confidence: 99%

Brain‐responsive corticothalamic stimulation in the pulvinar nucleus for the treatment of regional neocortical epilepsy: A case series

et al. 2021

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Drug‐resistant focal epilepsy with regional neocortical seizure onsets originating from the posterior quadrant can be particularly difficult to treat with resective surgery due to the overlap with eloquent cortex. Published reports indicate that corticothalamic treatment targeting the anterior or centromedian nucleus of the thalamus with direct brain‐responsive stimulation may be an effective approach to treat regional neocortical epilepsy. The pulvinar has remained largely unstudied as a neurostimulation target to treat refractory epilepsy. Because the pulvinar has connections with the posterior quadrant, neurostimulation may be effective if applied to seizures originating in this area. We performed a retrospective chart review of patients with regional neocortical seizure onsets in the posterior quadrant treated with the RNS System. Demographics, epilepsy history, clinical seizure frequencies, and neuropsychological testing results were obtained from the chart. Electrocorticogram (ECoG) records stored by the RNS System were reviewed to evaluate electrographic seizure onset patterns. Our patients were followed for 10, 12.5, and 15 months. All patients were responders (≥50% seizure reduction), and two of the three patients experienced a ≥90% reduction in seizures at the last follow‐up. Pre‐ and postsurgical neuropsychological evaluations were compared for two of the patients, and there was no evidence of cognitive decline found in either patient. Interestingly, mild cognitive improvements were reported. The third patient had only postimplant neuropsychological testing data available. Findings for this patient suggested executive dysfunction that was present prior to the RNS System which did not worsen with surgery. A visual inspection of ECoGs revealed near‐simultaneous seizure onsets in neocortical and pulvinar leads in two patients. Seizure onsets in the third patient were more variable. This is the first published report of brain‐responsive neurostimulation targeting the pulvinar to treat refractory regional onset epilepsy of posterior quadrant origin.

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“…21 Mayo Clinic investigators have demonstrated a posterior extraventricular approach to ANT. 23 Only two of our 25 reporting surgeons employed an extraventricular approach.…”

Section: Discussionmentioning

confidence: 99%

“…How segmented leads for directional DBS can be used to expand the therapeutic window of DBS in epilepsy is presently unknown. 23 The parameters chosen for the SANTE clinical trial were constant voltage stimulation at 5 V, with 90-µs pulses at 145 pulses per second, with each train ramped up over 8 s. Stimulation was on for 1 min and off for 5 min. These parameters were chosen partly from imitation of VNS parameters and partly from educated guesswork.…”

Section: F I G U R E 2 Suggested Flowchart For Deep Brain Stimulation Of the Anterior Nuclei Of Thalamus (Ant-dbs)mentioning

confidence: 99%

Experience and consensus on stimulation of the anterior nucleus of thalamus for epilepsy

et al. 2021

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show abstract

Precision mapping of the epileptogenic network with low- and high-frequency stimulation of anterior nucleus of thalamus

Cited by 21 publications

References 32 publications

Auditory driven gamma synchrony is associated with cortical thickness in widespread cortical areas

Auditory driven gamma synchrony is associated with cortical thickness in widespread cortical areas

Brain‐responsive corticothalamic stimulation in the pulvinar nucleus for the treatment of regional neocortical epilepsy: A case series

Experience and consensus on stimulation of the anterior nucleus of thalamus for epilepsy

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