Abstract
Presently, at least 60 million people are suffering from epilepsy worldwide. Although multiple pharmacological options for treatment exist, about 30% to 40% of these patients are estimated to have drug-resistant epilepsy (DRE), which is associated with severe disability and morbidity. The surgical treatment options are restricted to either open surgical procedures or laser ablations. When a resective option is not favorable, then neuromodulation options such as vagal nerve stimulation and deep brain stimulation are considered. A relatively recent and more commonly used clinical application is the deep brain stimulation (DBS) of the anterior thalamic nucleus, FDA approval for which was obtained in 2018. Furthermore, new technological advances in DBS technology are expected to positively impact the treatment options of these patients.
Highlights
BackgroundNot all patients with medically refractory epilepsy are suitable candidates for surgical resection intervention
Some patients may be suitable candidates for resective surgery, they are sometimes reluctant to undergo surgery owing to the invasiveness and the associated risk factors
When a patient has been diagnosed with drugresistant epilepsy (DRE), an evaluation in a tertiary center is recommended to evaluate their candidacy for surgery
Summary
Not all patients with medically refractory epilepsy are suitable candidates for surgical resection intervention. This study was a multicenter, randomized controlled, prospective, doubleblind clinical trial of stimulation of the anterior nuclei of thalamus for epilepsy in 110 patients (18-65 years old) These subjects were diagnosed with partial and generalized seizures occurring at least six times per month but not more than 10 per day, as recorded in a three-month daily seizure diary. According to the SANTE trial, the U.S Food and Drug Administration approved DBS therapy for epilepsy in 2018, stating, “Bilateral stimulation of the anterior nucleus of the thalamus (ANT) for epilepsy is indicated as an adjunctive therapy for reducing the frequency of seizures in individuals 18 years of age or older diagnosed with epilepsy characterized by partial-onset seizures with or without secondary generalization that are refractory to three or more antiepileptic medications.”. Despite the interest and research evidence in ANT DBS for epilepsy, a clear understanding of the physiological mechanism, optimal programming, best targeting and lead placement techniques, ideal candidates and contraindications still is challenging [45,46]
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