Electrode location and clinical outcome in hippocampal electrical stimulation for mesial temporal lobe epilepsy

Bondallaz, Percy; Boëx, Colette; Rossetti, Andrea O.; Foletti, G.; Spinelli, Laurent; Vulliémoz, Serge; Seeck, Margitta; Pollo, Claudio

doi:10.1016/j.seizure.2013.02.007

Cited by 69 publications

(62 citation statements)

References 32 publications

(52 reference statements)

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“…Hippocampal stimulation alone has shown additional efficacy for the control of focal medically refractory epilepsy. [1][2][3]10,11,[16][17][18][19][20][21][22] It is not yet known if combined AN and hippocampal stimulation would be more effective than stimulation at either site alone, and it is not clear how to best combine the stimulating parameters for the 2 targets.…”

Section: Discussionmentioning

confidence: 99%

Anterior nuclear deep brain stimulation guided by concordant hippocampal recording

Gompel¹,

Klassen

Worrell

et al. 2015

FOC

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OBJECT Anterior nuclear (AN) stimulation has been reported to reduce the frequency of seizures, in some cases dramatically; however, it has not been approved by the US Food and Drug Administration. The anterior nucleus is difficult to target because of its sequestered location, partially surrounded by the ventricle. It has traditionally been targeted by using transventricular or lateral transcortical routes. Here, the authors report a novel approach to targeting the anterior nucleus and neurophysiologically confirming effective stimulation of the target, namely evoked potentials in the hippocampus. METHODS Bilateral AN 3389 electrodes were placed in a novel trajectory followed by bilateral hippocampal 3391 electrodes from a posterior trajectory. Each patient was implanted bilaterally with a Medtronic Activa PC+S device under an investigational device exemption approval. Placement was confirmed with CT. AN stimulation-induced hippocampal evoked potentials were measured to functionally confirm placement in the anterior nucleus. RESULTS Two patients had implantations by way of a novel AN trajectory with concomitant hippocampal electrodes. There were no lead misplacements. Postoperative stimulation of the anterior nucleus with a PC+S device elicited evoked potentials in the hippocampus. Thus far, both patients have reported a > 50% improvement in seizure frequency. CONCLUSIONS Placing AN electrodes posteriorly may provide a safer trajectory than that used for traditionally placed AN electrodes. In addition, with a novel battery that is capable of electroencephalographic recording, evoked potentials can be used to functionally assess the Papez circuit. This treatment paradigm may offer increased AN stimulation efficacy for medically intractable epilepsy by assessing functional placement more effectively and thus far has proven safe.

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Section: Discussionmentioning

confidence: 99%

Anterior nuclear deep brain stimulation guided by concordant hippocampal recording

Gompel¹,

Klassen

Worrell

et al. 2015

FOC

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“…In the 2 patients with presumed HS, monopolar stimulation appeared to be more effective than bipolar, but there did not appear to be significant differences between monopolar and bipolar stimulation in nonlesional patients. Interestingly, a subsequent reanalysis of this cohort demonstrated that all 6 patients with >50 % seizure frequency reduction had active contacts located within 3 mm of the subiculum [26], whereas the 2 nonresponders had electrodes >3 mm from the subiculum. In contrast, proximity to the presumed seizure onset zone was not associated with outcome, with responders' and nonresponders' active contacts located 11± 4.3 mm and 9.1± 2.3 mm from the ictal onset zone, respectively.…”

Section: Hippocampal Formationmentioning

confidence: 90%

“…The ANT projects to the cingulate gyrus, then to the parahippocampal gyrus, followed by the entorhinal cortex, which finally projects via the perforant pathway back to the hippocampus [19,20]. Supporting the notion that neural networks provide multiple points for potential therapeutic interactions, lesions and high-frequency electrical stimulation at several locations along this pathway-including the hippocampus, mammillary bodies, subiculum, and ANT-have demonstrated effective modulation of seizure propagation [22][23][24][25][26][27].…”

mentioning

confidence: 99%

Deep Brain Stimulation for the Treatment of Epilepsy: Circuits, Targets, and Trials

2014

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Deep brain stimulation (DBS) has proven remarkably safe and effective in the treatment of movement disorders. As a result, it is being increasingly applied to a range of neurologic and psychiatric disorders, including medically refractory epilepsy. This review will examine the use of DBS in epilepsy, including known targets, mechanisms of neuromodulation and seizure control, published clinical evidence, and novel technologies. Cortical and deep neuromodulation for epilepsy has a long experimental history, but only recently have better understanding of epileptogenic networks, precise stereotactic techniques, and rigorous trial design combined to improve the quality of available evidence and make DBS a viable treatment option. Nonetheless, underlying mechanisms, anatomical targets, and stimulation parameters remain areas of active investigation.

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“…The outcomes showed that when the stimulation electrode was closer to the subiculum, the effects of stimulation were higher. The Bondallaz et al [33] study is the first clinical study supporting the participation of the subiculum in seizure generation and propagation.…”

Section: Effects Of Hfs On Spontaneous Seizuresmentioning

confidence: 96%

“…Besides evidence from animal models, Bondallaz et al [33] recently delivered HFS (130 Hz) in the hippocampus to investigate the relationship of stimulation and distance between stimulation contact and focus in eight patients with refractory epilepsy. The outcomes showed that when the stimulation electrode was closer to the subiculum, the effects of stimulation were higher.…”

Section: Effects Of Hfs On Spontaneous Seizuresmentioning

confidence: 99%

Effects of Responsive and Scheduled Stimulation in the Subiculum on Seizures and Excitability in the Kainate Induced Temporal Lobe Epilepsy Model

van¹

2014

Int J Neurorehabilitation Eng

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Objective: The subiculum, one major output structure in the hippocampus, is considered to participate in seizure generation and modulation in temporal lobe epilepsy (TLE) since stimulation of the subiculum was found to suppress seizures in a seizure model. The current study aimed to investigate whether acute scheduled or responsive stimulation of the subiculum can suppress spontaneous seizures and affect local excitability of the subiculum in a chronic TLE model. Methods:Wistar rats were administrated intraperitoneally with kainic acid (KA) repeatedly to induce status epilepticus (SE). 4 months later the rats were implanted with stimulation electrodes in the subiculum. After one-week baseline recording, they received either responsive or scheduled high frequency stimulation (HFS, 125 Hz) for two days and then were swapped to the other type of stimulation for two days with one-week interval. All the rats also received pulse stimuli (100 µs, interval of 5-7 s) at different intensities (20, 50, 100 mA) before and after stimulation while evoked responses were elicited.Results: Acute HFS of the subiculum-both scheduled and responsive stimulation-suppressed spontaneous focal seizures in rats. The excitability of the subiculum, measured by evoked responses, did not show obvious changes before and after HFS. Conclusion:The preliminary outcomes revealed the anticonvulsant effects of subicular stimulation on spontaneous seizures, suggesting that the subiculum is a promising target candidate for deep brain stimulation to control seizures in TLE. The absence of changes in subicular excitability indicates that HFS affects the hippocampal network rather than the excitability of the subiculum per se. Effects of Responsive and

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Electrode location and clinical outcome in hippocampal electrical stimulation for mesial temporal lobe epilepsy

Abstract: Decrease of epileptogenic activity induced by hippocampal DBS in refractory MTLE: (1) seems not directly associated with the vicinity of active electrode to the ictal focus determined by invasive recordings; (2) might be obtained through the neuromodulation of the subiculum.

Cited by 69 publications

References 32 publications

Anterior nuclear deep brain stimulation guided by concordant hippocampal recording

Anterior nuclear deep brain stimulation guided by concordant hippocampal recording

Deep Brain Stimulation for the Treatment of Epilepsy: Circuits, Targets, and Trials

Effects of Responsive and Scheduled Stimulation in the Subiculum on Seizures and Excitability in the Kainate Induced Temporal Lobe Epilepsy Model

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