Centromedian thalamic responsive neurostimulation for Lennox‐Gastaut epilepsy and autism

Kwon, Churl‐Su; Schüpper, Alexander J.; Fields, Madeline; Marcuse, Lara; Vega‐Talbott, Maite La; Panov, Fedor; Ghatan, Saadi

doi:10.1002/acn3.51173

Cited by 57 publications

(58 citation statements)

References 23 publications

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“…Leveraging the diffuse connectivity profile of this region, the CM has been successfully targeted by DBS for the treatment of drug-resistant PGE ( 8 , 9 , 15 , 35 , 36 ). RNS stimulation of the CM has been applied in adult patients for the treatment of drug-resistant regional neocortical epilepsy ( 37 ), generalized epilepsy ( 26 ), Lennox-Gastaut Syndrome ( 10 , 38 ), and drug-resistant focal onset-seizures ( 39 ). Seizure frequency of patients with implanted RNS systems often continues to improve over months to years, which implicates the role of neural plasticity induced by programmable closed-loop stimulation ( 16 , 23 ).…”

Section: Discussionmentioning

confidence: 99%

Case Report: Responsive Neurostimulation of the Centromedian Thalamic Nucleus for the Detection and Treatment of Seizures in Pediatric Primary Generalized Epilepsy

2021

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Up to 20% of pediatric patients with primary generalized epilepsy (PGE) will not respond effectively to medication for seizure control. Responsive neurostimulation (RNS) is a promising therapy for pediatric patients with drug-resistant epilepsy and has been shown to be an effective therapy for reducing seizure frequency and severity in adult patients. RNS of the centromedian nucleus of the thalamus may help to prevent loss of awareness during seizure activity in PGE patients with absence seizures. Here we present a 16-year-old male, with drug-resistant PGE with absence seizures, characterized by 3 Hz spike-and-slow-wave discharges on EEG, who achieved a 75% reduction in seizure frequency following bilateral RNS of the centromedian nuclei. At 6-months post-implant, this patient reported complete resolution of the baseline daily absence seizure activity, and decrease from 3–4 generalized convulsive seizures per month to 1 per month. RNS recordings showed well-formed 3 Hz spike-wave discharges in bilateral CM nuclei, further supporting the notion that clinically relevant ictal discharges in PGE can be detected in CM. This report demonstrates that CM RNS can detect PGE-related seizures in the CM nucleus and deliver therapeutic stimulation.

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Section: Discussionmentioning

confidence: 99%

Case Report: Responsive Neurostimulation of the Centromedian Thalamic Nucleus for the Detection and Treatment of Seizures in Pediatric Primary Generalized Epilepsy

2021

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“…A common strategy for implantation of RNS System leads is to combine cortical strip and thalamic depth leads (“corticothalamic” approach) ( Elder et al, 2019 ; Herlopian et al, 2019 ; Burdette et al, 2020 ; Kokkinos et al, 2020 ; Kwon et al, 2020 ). While this is done to disrupt epileptogenic network activity at both the sites of origin and spread, there is also uncertainty about the ability to detect electrographic seizures in thalamic nuclei with the RNS System ( Burdette et al, 2020 ).…”

Section: Introductionmentioning

confidence: 99%

Responsive Neurostimulation Targeting the Anterior, Centromedian and Pulvinar Thalamic Nuclei and the Detection of Electrographic Seizures in Pediatric and Young Adult Patients

Beaudreault

Muh

Naftchi

et al. 2022

Front. Hum. Neurosci.

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BackgroundResponsive neurostimulation (RNS System) has been utilized as a treatment for intractable epilepsy. The RNS System delivers stimulation in response to detected abnormal activity, via leads covering the seizure foci, in response to detections of predefined epileptiform activity with the goal of decreasing seizure frequency and severity. While thalamic leads are often implanted in combination with cortical strip leads, implantation and stimulation with bilateral thalamic leads alone is less common, and the ability to detect electrographic seizures using RNS System thalamic leads is uncertain.ObjectiveThe present study retrospectively evaluated fourteen patients with RNS System depth leads implanted in the thalamus, with or without concomitant implantation of cortical strip leads, to determine the ability to detect electrographic seizures in the thalamus. Detailed patient presentations and lead trajectories were reviewed alongside electroencephalographic (ECoG) analyses.ResultsAnterior nucleus thalamic (ANT) leads, whether bilateral or unilateral and combined with a cortical strip lead, successfully detected and terminated epileptiform activity, as demonstrated by Cases 2 and 3. Similarly, bilateral centromedian thalamic (CMT) leads or a combination of one centromedian thalamic alongside a cortical strip lead also demonstrated the ability to detect electrographic seizures as seen in Cases 6 and 9. Bilateral pulvinar leads likewise produced reliable seizure detection in Patient 14. Detections of electrographic seizures in thalamic nuclei did not appear to be affected by whether the patient was pediatric or adult at the time of RNS System implantation. Sole thalamic leads paralleled the combination of thalamic and cortical strip leads in terms of preventing the propagation of electrographic seizures.ConclusionThalamic nuclei present a promising target for detection and stimulation via the RNS System for seizures with multifocal or generalized onsets. These areas provide a modifiable, reversible therapeutic option for patients who are not candidates for surgical resection or ablation.

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“…Further, neuromodulation targeting brain structures is becoming an increasingly popular treatment for drug-resistant epilepsy [29] , [30] . This includes electrode placement in the centromedian nucleus which is intimately connected to the basal ganglia [31] , [32] . Therefore, identification of relevant interictal biomarkers in these regions are increasing important.…”

Section: Discussionmentioning

confidence: 99%

Spike ripples in striatum correlate with seizure risk in two mouse models

Shi

Zemel

Sridhar

et al. 2022

Epilepsy & Behavior Reports

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Centromedian thalamic responsive neurostimulation for Lennox‐Gastaut epilepsy and autism

Cited by 57 publications

References 23 publications

Case Report: Responsive Neurostimulation of the Centromedian Thalamic Nucleus for the Detection and Treatment of Seizures in Pediatric Primary Generalized Epilepsy

Case Report: Responsive Neurostimulation of the Centromedian Thalamic Nucleus for the Detection and Treatment of Seizures in Pediatric Primary Generalized Epilepsy

Responsive Neurostimulation Targeting the Anterior, Centromedian and Pulvinar Thalamic Nuclei and the Detection of Electrographic Seizures in Pediatric and Young Adult Patients

Spike ripples in striatum correlate with seizure risk in two mouse models

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