Deep brain stimulation of thalamus for epilepsy

Fisher, Robert S.

doi:10.1016/j.nbd.2023.106045

Cited by 41 publications

(34 citation statements)

References 200 publications

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“…Targeting of the ANT has been reported to be simpler, as it can be easily delineated on fast gray matter acquisition T1 inversion recovery magnetic resonance imaging, whereas the CMN has less clear borders and can be difficult to target directly using structural neuroimaging 60,61 . This may affect preference on thalamic target in addition to the therapeutic considerations noted above.…”

Section: Discussionmentioning

confidence: 99%

“…This may affect preference on thalamic target in addition to the therapeutic considerations noted above. Optimal targeting of the ANT is typically achieved by aiming for the junction of the mammillothalamic tract with the anterior border of the nucleus, although indirect targeting of the CMN paired with intraoperative microelectrode recording has been shown to be effective 61 . Other thalamic targets, including the pulvinar nucleus, based off its diffuse projection to limbic, auditory, and visual cortex, have been studied in a very small number of patients with limited efficacy 61 .…”

Section: Discussionmentioning

confidence: 99%

“…59 Targeting of the ANT has been reported to be simpler, as it can be easily delineated on fast gray matter acquisition T1 inversion recovery magnetic resonance imaging, whereas the CMN has less clear borders and can be difficult to target directly using structural neuroimaging. 60,61 This may affect preference on thalamic target in addition to the therapeutic considerations noted above. Optimal targeting of the ANT is typically achieved by aiming for the junction of the mammillothalamic tract with the anterior border of the nucleus, although indirect targeting of the CMN paired with intraoperative microelectrode recording has been shown to be effective.…”

Section: Characteristic N (%)mentioning

confidence: 99%

“…61 Other thalamic targets, including the pulvinar nucleus, based off its diffuse projection to limbic, auditory, and visual cortex, have been studied in a very small number of patients with limited efficacy. 61 No study in this series reported on outcomes of pulvinar stimulation in pediatric patients. Further study comparing each of these targets against each other in generalized phenotypes is required.…”

Section: Characteristic N (%)mentioning

confidence: 99%

“…Variability in stimulation settings stems from the plethora of parameters to choose from, including target site, constant voltage or current, frequency, pulse width, montage polarities, and patterns of stimulus trains. 61 Limited international consensus guidelines exist to guide clinicians in standardization, and further guidance is necessary to help understand effective treatment of epilepsy with neurostimulation. 66,67 As with most studies focusing on seizure reduction as an outcome, there was high variability in terms of how seizure frequency was assessed (EEG findings vs. RNS findings vs. patient seizure diaries), which could introduce recall bias in reporting of the treatment response of ≥50% seizure reduction.…”

Section: Characteristic N (%)mentioning

confidence: 99%

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Predictors of therapeutic response following thalamic neuromodulation for drug‐resistant pediatric epilepsy: A systematic review and individual patient data meta‐analysis

Sharma,

Parfyonov,

Tiefenbach

et al. 2024

Epilepsia

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We sought to perform a systematic review and individual participant data meta‐analysis to identify predictors of treatment response following thalamic neuromodulation in pediatric patients with medically refractory epilepsy. Electronic databases (MEDLINE, Ovid, Embase, and Cochrane) were searched, with no language or data restriction, to identify studies reporting seizure outcomes in pediatric populations following deep brain stimulation (DBS) or responsive neurostimulation (RNS) implantation in thalamic nuclei. Studies featuring individual participant data of patients with primary or secondary generalized drug‐resistant epilepsy were included. Response to therapy was defined as >50% reduction in seizure frequency from baseline. Of 417 citations, 21 articles reporting on 88 participants were eligible. Mean age at implantation was 13.07 ± 3.49 years. Fifty (57%) patients underwent DBS, and 38 (43%) RNS. Sixty (68%) patients were implanted in centromedian nucleus and 23 (26%) in anterior thalamic nucleus, and five (6%) had both targets implanted. Seventy‐four (84%) patients were implanted bilaterally. The median time to last follow‐up was 12 months (interquartile range = 6.75–26.25). Sixty‐nine percent of patients achieved response to treatment. Age, target, modality, and laterality had no significant association with response in univariate logistic regression. Until thalamic neuromodulation gains widespread approval for use in pediatric patients, data on efficacy will continue to be limited to small retrospective cohorts and case series. The inherent bias of these studies can be overcome by using individual participant data. Thalamic neuromodulation appears to be a safe and effective treatment for epilepsy. Larger, prolonged prospective, multicenter studies are warranted to further evaluate the efficacy of DBS over RNS in this patient population where resection for curative intent is not a safe option.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Characteristic N (%)mentioning

confidence: 99%

Section: Characteristic N (%)mentioning

confidence: 99%

Section: Characteristic N (%)mentioning

confidence: 99%

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Predictors of therapeutic response following thalamic neuromodulation for drug‐resistant pediatric epilepsy: A systematic review and individual patient data meta‐analysis

Sharma,

Parfyonov,

Tiefenbach

et al. 2024

Epilepsia

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Septal stimulation attenuates hippocampal seizure with subregion specificity

Zhang,

Wang,

Wang

et al. 2024

Epilepsia Open

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ObjectiveDeep brain stimulation (DBS) is a promising approach for the treatment of epilepsy. However, the optimal target for DBS and underlying mechanisms are still not clear. Here, we compared the therapeutic effects of DBS on distinct septal subregions, aimed to find the precise targets of septal DBS and related mechanisms for the clinical treatment.MethodsAssisted by behavioral test, electroencephalography (EEG) recording and analyzing, selectively neuronal manipulation and immunohistochemistry, we assessed the effects of DBS on the three septal subregions in kainic acid (KA)‐induced mouse seizure model.ResultsDBS in the medial septum (MS) not only delayed generalized seizure (GS) development, but reduced the severity; DBS in the vertical diagonal band of Broca (VDB) only reduced the severity of GS, while DBS in the horizontal diagonal band of Broca (HDB) subregion showed no anti‐seizure effect. Notably, DBS in the MS much more efficiently decreased abnormal activation of hippocampal neurons. EEG spectrum analysis indicated that DBS in the MS and VDB subregions mainly increased the basal hippocampal low‐frequency (delta and theta) rhythm. Furthermore, ablation of cholinergic neurons in the MS and VDB subregions blocked the anti‐seizure and EEG‐modulating effects of septal DBS, suggesting the seizure‐alleviating effect of DBS was dependent on local cholinergic neurons.SignificanceDBS in the MS and VDB, rather than HDB, attenuates hippocampal seizure by activation of cholinergic neurons‐augmented hippocampal delta/theta rhythm. This may be of great therapeutic significance for the clinical treatment of epilepsy with septal DBS.Plain Language SummaryThe optical target of deep brain stimulation in the septum is still not clear. This study demonstrated that stimulation in the medial septum and vertical diagonal band of Broca subregions, but not the horizontal diagonal band of Broca, could alleviate hippocampal seizure through cholinergic neurons‐augmented hippocampal delta/theta rhythm. This study may shed light on the importance of precise regulation of deep brain stimulation therapy in treating epileptic seizures.

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