Abstract
The centromedian (CM) and anterior nucleus of the thalamus (ANT) are deep brain stimulation (DBS) targets for management of generalized, and focal drug resistant epilepsy (DRE), respectively. We report on a single center retrospective case series of 16 children and adults with DRE who underwent CM with simultaneous ANT (69 %) or CM without simultaneous ANT DBS (31 %). Seizure frequency, epilepsy severity, life satisfaction, and quality of sleep before and after DBS were compared. Baseline median seizure frequency was 323 seizures per month (IQR, 71–563 sz/mo). Median follow up time was 80 months (IQR 37–97 mo). Median seizure frequency reduction was 58 % (IQR 13–87 %, p = 0.002). Ten patients (63 %) reported ≥50 % seizure frequency reduction. Median seizure frequency reduction and responder rate were not significantly different for CM + ANT versus CM only. Seizure severity and life satisfaction were significantly improved. Three patients (19 %) developed device-related side effects, 2 of them (12.5 %) required surgical intervention. In a heterogenous population of children and adults with generalized, multifocal, posterior onset, and poorly localized DRE, CM with or without ANT DBS is feasible, relatively safe and is associated with reduced seizure frequency and severity, as well as improved life satisfaction.
Highlights
There are over 45.9 million people living with epilepsy worldwide [1]
Stimulation of anterior nucleus of thalamus for epilepsy (SANTE) trial demonstrated the efficacy of anterior thalamic nuclei stimulation (ANT) as a treatment modality for frontal or temporal drug-resistant epilepsy (DRE) and is FDA approved for treatment of focal seizures [7,8]
Patients had previously tried a median of nine anti-seizure drugs (ASD) (IQR, 6–12) before deep brain stimulation (DBS) and were taking a median of three (IQR, 2–4) at the time of DBS im plantation
Summary
Around 30 % of patients with epilepsy are drug-resistant [2]. There are several neuromodulation strategies available for epilepsy management including vagus nerve stimulation (VNS), responsive neurostimulation (RNS), and deep brain stimulation (DBS). Stimulation of anterior nucleus of thalamus for epilepsy (SANTE) trial demonstrated the efficacy of anterior thalamic nuclei stimulation (ANT) as a treatment modality for frontal or temporal DRE and is FDA approved for treatment of focal seizures [7,8]. CM DBS has shown efficacy in pa tients with generalized epilepsy, it is not an FDA-approved approach; CM DBS has been less effective in patients with frontal or temporal lobe DRE in small controlled clinical trials [10,11]
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