Centromedian thalamic neuromodulation for the treatment of idiopathic generalized epilepsy

Abstract

Idiopathic generalized epilepsy (IGE) is a common type of epilepsy and despite an increase in the number of available anti-seizure medications, approximately 20–30% of people with IGE continue to experience seizures despite adequate medication trials. Unlike focal epilepsy, resective surgery is not a viable treatment option for IGE; however, neuromodulation may be an effective surgical treatment for people with IGE. Thalamic stimulation through deep brain stimulation (DBS) and responsive neurostimulation (RNS) have been explored for the treatment of generalized and focal epilepsies. Although the data regarding DBS and RNS in IGE is limited to case reports and case series, the results of the published studies have been promising. The current manuscript will review the published literature of DBS and RNS within the centromedian nucleus of the thalamus for the treatment of IGE, as well as highlight an illustrative case.

Long‐term efficacy of deep brain stimulation of the subthalamic nucleus in patients with pharmacologically intractable epilepsy: A case series of six patients

“…Based on the results of randomized controlled trials and larger clinical series, the best evidence exists for DBS of the anterior thalamic nucleus. Studies of DBS to CMT have reported significant reductions in seizures following implantation and stimulation, [42][43][44][45] although randomized trials are required. 13 Some researchers suggest more efficient deep brain stimulation of ANT for focal seizures, wider use of CMT for generalized seizures, and hippocampal DBS for temporal lobe seizures.…”

Management of epilepsy with eyelid myoclonia: Results of an international expert consensus panel

“…3,19 The use of neuromodulation is being studied and expanded for the treatment of some generalized epilepsy syndromes, with some promising early data in idiopathic generalized epilepsies. 20 A patient with drug-resistant EEM underwent responsive neurostimulation targeting the centromedian/ ventrolateral nucleus of the thalamus, which reduced daily absence seizures from 60 to ≤10. 21 Further work is necessary to understand the use of neuromodulation in this syndrome and the optimal target.…”

“…However, fenfluramine was found to be effective in a study of 10 patients with sunflower syndrome, which has been classified as a subgroup of EEM with prominent photic stimulation 3,19 . The use of neuromodulation is being studied and expanded for the treatment of some generalized epilepsy syndromes, with some promising early data in idiopathic generalized epilepsies 20 . A patient with drug‐resistant EEM underwent responsive neurostimulation targeting the centromedian/ventrolateral nucleus of the thalamus, which reduced daily absence seizures from 60 to ≤10 21 .…”

Multisite Thalamic Recordings to Characterize Seizure Propagation in the Human Brain

“…Given clinical limitations, the final number of thalamic electrodes ranged from 1-5 to monitor 1-6 thalamic nuclei. We did not implant in the centromedian thalamic nucleus in this series because its location was not within the trajectory of most other targets, and because it may be more involved with non-temporal lobe epilepsies(Velasco et al ., 1987; Fisher et al ., 1992; Velasco et al ., 2006; Zillgitt et al ., 2022)…”

“…Given clinical limitations, the final number of thalamic electrodes ranged from 1-5 to monitor 1-6 thalamic nuclei. We did not implant in the centromedian thalamic nucleus in this series because its location was not within the trajectory of most other targets, and because it may be more involved with non-temporal lobe epilepsies (Velasco et al, 1987;Fisher et al, 1992;Velasco et al, 2006;Zillgitt et al, 2022) Electrode trajectory planning: High resolution T1, fast gray matter acquisition T1 inversion recovery (FGATIR), and T1 post-contrast imaging were used for planning. All patients required frontal and temporal opercular and/or insular coverage.…”