Successful management of super‐refractory status epilepticus with thalamic deep brain stimulation

Lehtimäki, Kai; Långsjö, Jaakko; Ollikainen, Jyrki; Heinonen, Hanna; Möttönen, Timo; Tähtinen, Timo; Haapasalo, Joonas; Tenhunen, Jyrki; Katisko, Jani; Öhman, Juha; Peltola, Jukka

doi:10.1002/ana.24821

Cited by 39 publications

(51 citation statements)

References 13 publications

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“…A recent review of case reports describing use of electro-convulsive therapy to treat RSE/SRSE found electrographic resolution in 6 out of 8 cases, but recovery to baseline in only 2 patients [54]. Isolated reports describe also successful use of anterior thalamic deep-brain stimulation to treat RSE/SRSE [55]. Similar to VNS, the ketogenic diet (KD) has been administered to patients with RSE and SRSE in clinical practice however with fewer cases reported than for VNS.…”

Section: Discussionmentioning

confidence: 99%

Vagus nerve stimulation in refractory and super-refractory status epilepticus – A systematic review

et al. 2019

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Rationale: Refractory status epilepticus (RSE) is the persistence of status epilepticus despite second-line treatment. Super-refractory SE (SRSE) is characterized by ongoing status despite 48 h of anaesthetic treatment. Due to the high case fatality in RSE of 16e39%, off label treatments without strong evidence of efficacy in RSE are often administered. In single case-reports and small case series totalling 28 patients, acute implantation of VNS in RSE was associated with 76% and 26% success rate in generalized and focal RSE respectively. We performed an updated systematic review of the literature on efficacy of VNS in RSE/ SRSE by including all reported patients. Methods: We systematically searched EMBASE, CENTRAL, Opengre.eu, and ClinicalTrials.gov, and PubMed databases to identify studies reporting the use of VNS for RSE and/or SRSE. We also searched conference abstracts from AES and ILAE meetings. Results: 45 patients were identified in total of which 38 were acute implantations of VNS in RSE/SRSE. Five cases had VNS implantation for epilepsia partialis continua, one for refractory electrical status epilepticus in sleep and one for acute encephalitis with refractory repetitive focal seizures. Acute VNS implantation was associated with cessation of RSE/SRSE in 74% (28/38) of acute cases. Cessation did not occur in 18% (7/38) of cases and four deaths were reported (11%); all of them due to the underlying disease and unlikely related to VNS implantation. Median duration of the RSE/SRSE episode pre and post VNS implantation was 18 days (range: 3e1680 days) and 8 days (range: 3e84 days) respectively. Positive outcomes occurred in 82% (31/38) of cases. Conclusion: VNS can interrupt RSE and SRSE in 74% of patients; data originate from reported studies classified as level IV and the risk for reporting bias is high. Further prospective studies are warranted to investigate acute VNS in RSE and SRSE.

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Section: Discussionmentioning

confidence: 99%

Vagus nerve stimulation in refractory and super-refractory status epilepticus – A systematic review

et al. 2019

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“…A reduction in seizure severity is consistent with other studies; stimulation is effective against the most serious seizures, with a concomitant reduction in injuries. (2,4,8,21,22,23,24,25,26,27,28,29).…”

Section: Discussionmentioning

confidence: 99%

Anterior thalamic deep brain stimulation in refractory epilepsy: A randomized, double‐blinded study

et al. 2018

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The safety and effect on seizure frequency of anterior thalamic nucleus deep brain stimulation (ANT-DBS) were studied in this prospective, randomized, double-blinded study. Patients were followed for 12 months. The first 6 months were blinded with regard to active stimulation or not. After 6 months, all patients received active stimulation. Material and methods Bilateral ANT electrodes were implanted into 18 patients suffering from focal, pharmacoresistant epilepsy. Antiepileptic treatment was kept unchanged from three months prior to operation. The Liverpool seizure severity scale (LSSS) was used to measure the burden of epilepsy. Results There was no significant difference between the 2 groups at the end of the blinded period at 6 months. However, when considering all patients and comparing 6 months of stimulation with baseline, there was a significant, 22% reduction in the frequency of all seizures (p=0.009). Four patients had ≥ 50% reduction in total seizure frequency and 5 patients ≥ 50% reduction in focal seizures after 6 months of stimulation. No increased effect over time was shown. LSSS at 6 months compared to baseline showed no significant difference between the 2 groups, but a small, significant reduction in LSSS was found when all patients had received stimulation for 6 months. Conclusions Our study supports results from earlier studies concerning DBS as a safe treatment option, with effects even in patients with severe, refractory epilepsy. However, our results are not as encouraging as those reported from many other, mainly unblinded, and open studies.

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“…The remaining 1067 articles were excluded on the basis of not meeting one or both of these criteria. Results of all 41 studies are summarized in Table 1 1-6, 10-13, 15-17,19,20, 23-25,29-40, 42,44,48, 49, 51-57 and the most frequently studied stimulation targets were the ANT (20 studies 1,5, 11, 15, 16, 19, 25,29,30,32,34,37-40, 48, 49, 53-55 ), the CMT (7 studies 10,11,31,44,[51][52][53], and the HCP (10 studies 3,4,11,12,13,20,33,35,36,56 ). It is noteworthy that some articles evaluated multiple targets and are included more than once.…”

Section: Overall Findingsmentioning

confidence: 99%

“…Seven studies over the past decade have investigated the use of CMT DBS for the treatment of epilepsy in 35 patients. 10,11,31,44,[51][52][53] Treatment response rates range from 50% to 100%, depending on the study and the type of epilepsy being treated. The largest series, published by Son et al in 2016, 44 reported a 79% response rate (11 of 14 patients), with a mean seizure frequency reduction of 68%.…”

Section: Centromedian Nucleus Of the Thalamusmentioning

confidence: 99%

“…The patient developed a wound infection 6 months postprocedure and required device explantation; however, symptoms reportedly did not recur. In 2017, Lehtimäki et al 31 reported the case of a 17-year-old male patient with refractory status epilepticus thought to be secondary to common variable immunodeficiency-associated encephalomyelitis. Bilateral high-frequency 180-Hz DBS, coupled with a continuous S-ketamine infusion, proved effective in terminating the status epilepticus.…”

Section: Centromedian Nucleus Of the Thalamusmentioning

confidence: 99%

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Open-loop deep brain stimulation for the treatment of epilepsy: a systematic review of clinical outcomes over the past decade (2008–present)

Zhou¹,

Chen²,

Farber³

et al. 2018

Neurosurgical Focus

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OBJECTIVEThe field of deep brain stimulation (DBS) for epilepsy has grown tremendously since its inception in the 1970s and 1980s. The goal of this review is to identify and evaluate all studies published on the topic of open-loop DBS for epilepsy over the past decade (2008 to present).METHODSA PubMed search was conducted to identify all articles reporting clinical outcomes of open-loop DBS for the treatment of epilepsy published since January 1, 2008. The following composite search terms were used: (“epilepsy” [MeSH] OR “seizures” [MeSH] OR “kindling, neurologic” [MeSH] OR epilep* OR seizure* OR convuls*) AND (“deep brain stimulation” [MeSH] OR “deep brain stimulation” OR “DBS”) OR (“electric stimulation therapy” [MeSH] OR “electric stimulation therapy” OR “implantable neurostimulators” [MeSH]).RESULTSThe authors identified 41 studies that met the criteria for inclusion. The anterior nucleus of the thalamus, centromedian nucleus of the thalamus, and hippocampus were the most frequently evaluated targets. Among the 41 articles, 19 reported on stimulation of the anterior nucleus of the thalamus, 6 evaluated stimulation of the centromedian nucleus of the thalamus, and 9 evaluated stimulation of the hippocampus. The remaining 7 articles reported on the evaluation of alternative DBS targets, including the posterior hypothalamus, subthalamic nucleus, ventral intermediate nucleus of the thalamus, nucleus accumbens, caudal zone incerta, mammillothalamic tract, and fornix. The authors evaluated each study for overall epilepsy response rates as well as adverse events and other significant, nonepilepsy outcomes.CONCLUSIONSLevel I evidence supports the safety and efficacy of stimulating the anterior nucleus of the thalamus and the hippocampus for the treatment of medically refractory epilepsy. Level III and IV evidence supports stimulation of other targets for epilepsy. Ongoing research into the efficacy, adverse effects, and mechanisms of open-loop DBS continues to expand the knowledge supporting the use of these treatment modalities in patients with refractory epilepsy.

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Successful management of super‐refractory status epilepticus with thalamic deep brain stimulation

Cited by 39 publications

References 13 publications

Vagus nerve stimulation in refractory and super-refractory status epilepticus – A systematic review

Vagus nerve stimulation in refractory and super-refractory status epilepticus – A systematic review

Anterior thalamic deep brain stimulation in refractory epilepsy: A randomized, double‐blinded study

Open-loop deep brain stimulation for the treatment of epilepsy: a systematic review of clinical outcomes over the past decade (2008–present)

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