Deep brain stimulation of the centromedian thalamic nucleus for the treatment of FIRES

Hect, Jasmine L; Fernandez, Luis; Welch, William; Abel, Taylor J.

doi:10.1002/epi4.12568

Cited by 13 publications

(15 citation statements)

References 36 publications

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“…This review includes data from a total of 20 patients, but one patient underwent both VNS and DBS ( 43 ). Therefore, there were 21 neuromodulation treatments administered across 15 studies.…”

Section: Resultsmentioning

confidence: 99%

“…The mean duration from NORSE onset to the application of neuromodulation was 56 days with a median of 30 days. Eighteen out of the 20 patients had improvement after neuromodulation [21 treatments, as one patient had VNS which failed, followed by successful DBS ( 43 )], defined as resolution of SE and/or being able to step down from ICU. One of the patients with a resolution of SE after neuromodulation died from other comorbidities ( 48 ).…”

Section: Resultsmentioning

confidence: 99%

“…Regarding the overall outcomes, of the 17 survivors, 11 had persistent epilepsy ( 43 – 45 , 49 – 54 ), 12 had cognitive and/or motor dysfunction ( 43 , 45 – 47 , 49 – 53 , 55 , 56 ), and one remained in a vegetative state ( 50 ).…”

Section: Resultsmentioning

confidence: 99%

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Neuromodulation in new-onset refractory status epilepticus

2023

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BackgroundNew-onset refractory status epilepticus (NORSE) and its subset of febrile infection-related epilepsy syndrome (FIRES) are devastating clinical presentations with high rates of mortality and morbidity. The recently published consensus on the treatment of these conditions includes anesthetics, antiseizure drugs, antivirals, antibiotics, and immune therapies. Despite the internationally accepted treatment, the outcome remains poor for a significant percentage of patients.MethodsWe conducted a systematic review of the use of neuromodulation techniques in the treatment of the acute phase of NORSE/FIRES using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.ResultsOur search strategy brought up 74 articles of which 15 met our inclusion criteria. A total of 20 patients were treated with neuromodulation. Thirteen cases represented FIRES and in 17 cases the NORSE remained cryptogenic. Ten had electroconvulsive therapy (ECT), seven had vagal nerve stimulation (VNS), and four had deep brain stimulation (DBS); one patient had initially VNS and later DBS. Eight patients were female and nine were children. In 17 out of 20 patients, the status epilepticus was resolved after neuromodulation, while three patients died.ConclusionNORSE can have a catastrophic course and the first treatment goal should be the fastest possible termination of status epilepticus. The data presented are limited by the small number of published cases and the variability of neuromodulation protocols used. However, they show some potential clinical benefits of early neuromodulation therapy, suggesting that these techniques could be considered within the course of FIRES/NORSE.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Neuromodulation in new-onset refractory status epilepticus

2023

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“…Another patient (9 years old) with FIRES and RSE who underwent centromedian thalamic nuclei DBS (without anakinra treatment) demonstrated considerable improvement in baseline mental status 30 days after DBS insertion and ICU discharge, although seizure freedom was not achieved [17].…”

Section: Patient Selection and Outcomementioning

confidence: 99%

Epilepsiechirurgie beim therapierefraktären Status epilepticus des Kindesalters

Borggraefe,

Tacke,

Kunz

et al. 2023

Clin Epileptol

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The mainstay of status epilepticus (SE) treatment is pharmacotherapy with anti-seizure medications (ASM). In refractory status epilepticus (RSE), when additional ASM are not effective, high-dose suppressive therapy with either benzodiazepines, thiopental, phenobarbitone, or propofol is used to suppress clinical and EEG seizure activity. However, in selected eligible cases of RSE or in super-refractory cases, epilepsy surgery may be the treatment of choice to terminate SE. Here, we review epilepsy surgery including deep brain stimulation (DBS) for treatment for RSE with emphasis on special aspects of presurgical evaluation, patient selection, and outcome. We focus on surgical treatment options for patients in the acute phase of RSE, who have received high-dose suppressive therapy prior to surgery in the majority of the cases.

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“…Accurate target location and precise electrode implantation are the most important factors in achieving a satisfactory curative effect. The CMT is not directly visible using structural neuroimaging, so prior studies have targeted CMT using the Schaltenbrand atlas or empirical coordinates [15][16][17]. These approaches could lead to gross misplacement of electrodes outside the CMT in some cases [10,12].…”

Section: Introductionmentioning

confidence: 99%

Frameless Robot-Assisted Asleep Centromedian Thalamic Nucleus Deep Brain Stimulation Surgery in Patients with Drug-Resistant Epilepsy: Technical Description and Short-Term Clinical Results

et al. 2023

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Introduction: This purpose of this work is to give a detailed description of a surgical technique for frameless robot-assisted asleep deep brain stimulation (DBS) of the centromedian thalamic nucleus (CMT) in drug-resistant epilepsy (DRE). Methods: Ten consecutively enrolled patients who underwent CMT-DBS were included in the study. The FreeSurfer ''Thalamic Kernel Segmentation'' module and experience target coordinates were used for locating the CMT, and quantitative susceptibility mapping (QSM) images were used to check the target. The patient's head was secured with a head clip, and electrode implantation was performed with the assistance of the neurosurgical robot Sinovation Ò . After opening the dura, the burr hole was continuously flushed with physiological saline to stop air from entering the skull. All procedures were performed under general anesthesia without intraoperative microelectrode recording (MER). Results: The mean age of the patients at surgery and onset of seizures was 22 years (range 11-41 years) and 11 years (range 1-21 years), respectively. The median duration of seizures before CMT-DBS surgery was 10 years (2--26 years). CMT was successfully segmented, and its position was verified by experience target coordinates and QSM images in all ten patients. The mean surgical time for bilateral CMT-DBS in this cohort was 165 ± 18 min. The mean pneumocephalus volume was 2 cm 3 . The median absolute errors in the x-, y-, and z-axes were 0.7 mm, 0.5 mm, and 0.9 mm, respectively. The median Euclidean distance (ED) and radial error (RE) was 1.3 ± 0.5 mm and 1.0 ± 0.3 mm, respectively. No significant difference was found between right-and left-sided electrodes regarding the RE nor the ED. After a mean 12-month follow-up, the average reduction in seizures was 61%, and six patients experienced Changquan Wang and Jing Hong contributed equally.

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Deep brain stimulation of the centromedian thalamic nucleus for the treatment of FIRES

Cited by 13 publications

References 36 publications

Neuromodulation in new-onset refractory status epilepticus

Neuromodulation in new-onset refractory status epilepticus

Epilepsiechirurgie beim therapierefraktären Status epilepticus des Kindesalters

Frameless Robot-Assisted Asleep Centromedian Thalamic Nucleus Deep Brain Stimulation Surgery in Patients with Drug-Resistant Epilepsy: Technical Description and Short-Term Clinical Results

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