1
|
Jordán Z, Szabó JP, Sákovics A, Kelemen A, Halász L, Erőss L, Fabó D. Epileptiform discharges in the anterior thalamus of epilepsy patients. iScience 2024; 27:109582. [PMID: 38726366 PMCID: PMC11079473 DOI: 10.1016/j.isci.2024.109582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/25/2023] [Accepted: 03/25/2024] [Indexed: 05/12/2024] Open
Abstract
Anterior thalamus (ANT) deep-brain stimulation (DBS) is an approved therapy for drug resistant epilepsy. We aimed to identify interictal epileptiform discharges (IED) in the ANT and to investigate their relationship with surface IEDs. Fifteen patients were monitored for two consecutive nights with externalized thalamic leads to analyze the intrathalamic epileptiform activities (TIED). Forty-six % of all contacts were located within the ANT. We found that all the responders had TIEDs within the ANT, while this held true only for 44% of the non-responders. The overall response rate (RR) at 1-year follow-up was 40%, while it was 44% in bilateral ANT hit patients and 45% in epileptic focus side hit. However, in case of TIEDs present in the focus side the RR reached as high as 71%. TIED activity may prove the pathophysiological connection to the seizure focus, and stimulation of this area might have a better suppressing effect on seizures.
Collapse
Affiliation(s)
- Zsófia Jordán
- Epilepsy Unit, Department of Neurosurgery and Neurointervention, Faculty of Medicine, Semmelweis University, 1145 Budapest, Hungary
- Member of the ERN EpiCARE, Budapest, Hungary
| | - Johanna-Petra Szabó
- Epilepsy Unit, Department of Neurosurgery and Neurointervention, Faculty of Medicine, Semmelweis University, 1145 Budapest, Hungary
- Member of the ERN EpiCARE, Budapest, Hungary
- János Szentágothai Neuroscience Program, School of PhD Studies, Semmelweis University, 1085 Budapest, Hungary
- Lendület Laboratory of Systems Neuroscience, Institute of Experimental Medicine, 1083 Budapest, Hungary
| | - Anna Sákovics
- Epilepsy Unit, Department of Neurosurgery and Neurointervention, Faculty of Medicine, Semmelweis University, 1145 Budapest, Hungary
- Member of the ERN EpiCARE, Budapest, Hungary
- János Szentágothai Neuroscience Program, School of PhD Studies, Semmelweis University, 1085 Budapest, Hungary
| | - Anna Kelemen
- Epilepsy Unit, Department of Neurosurgery and Neurointervention, Faculty of Medicine, Semmelweis University, 1145 Budapest, Hungary
- Member of the ERN EpiCARE, Budapest, Hungary
- András Pető Faculty, Semmelweis University, 1125 Budapest, Hungary
| | - László Halász
- Functional Neurosurgery Unit, Department of Neurosurgery and Neurointervention, Faculty of Medicine, Semmelweis University, 1145 Budapest, Hungary
| | - Loránd Erőss
- Functional Neurosurgery Unit, Department of Neurosurgery and Neurointervention, Faculty of Medicine, Semmelweis University, 1145 Budapest, Hungary
| | - Dániel Fabó
- Epilepsy Unit, Department of Neurosurgery and Neurointervention, Faculty of Medicine, Semmelweis University, 1145 Budapest, Hungary
- Member of the ERN EpiCARE, Budapest, Hungary
- Department of Neurology, University of Szeged, 6720 Szeged, Hungary
| |
Collapse
|
2
|
Szalárdy O, Simor P, Ujma PP, Jordán Z, Halász L, Erőss L, Fabó D, Bódizs R. Temporal association between sleep spindles and ripples in the human anterior and mediodorsal thalamus. Eur J Neurosci 2024; 59:641-661. [PMID: 38221670 DOI: 10.1111/ejn.16240] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 12/01/2023] [Accepted: 12/08/2023] [Indexed: 01/16/2024]
Abstract
Sleep spindles are major oscillatory components of Non-Rapid Eye Movement (NREM) sleep, reflecting hyperpolarization-rebound sequences of thalamocortical neurons. Reports suggest a link between sleep spindles and several forms of high-frequency oscillations which are considered as expressions of pathological off-line neural plasticity in the central nervous system. Here we investigated the relationship between thalamic sleep spindles and ripples in the anterior and mediodorsal nuclei (ANT and MD) of epilepsy patients. Whole-night LFP from the ANT and MD were co-registered with scalp EEG/polysomnography by using externalized leads in 15 epilepsy patients undergoing a Deep Brain Stimulation protocol. Slow (~12 Hz) and fast (~14 Hz) sleep spindles were present in the human ANT and MD and roughly, 20% of them were associated with ripples. Ripple-associated thalamic sleep spindles were characterized by longer duration and exceeded pure spindles in terms of spindle power as indicated by time-frequency analysis. Furthermore, ripple amplitude was modulated by the phase of sleep spindles within both thalamic nuclei. No signs of pathological processes were correlated with measures of ripple and spindle association, furthermore, the density of ripple-associated sleep spindles in the ANT showed a positive correlation with verbal comprehension. Our findings indicate the involvement of the human thalamus in coalescent spindle-ripple oscillations of NREM sleep.
Collapse
Affiliation(s)
- Orsolya Szalárdy
- Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
- Institute of Cognitive Neuroscience and Psychology, Budapest, Hungary
| | - Péter Simor
- Institute of Psychology, ELTE, Eötvös Loránd University, Budapest, Hungary
- UR2NF, Neuropsychology and Functional Neuroimaging Research Unit at CRCN, Center for Research in Cognition and Neurosciences and UNI-ULB Neurosciences Institute, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Zsófia Jordán
- National Institute of Mental Health, Neurology and Neurosurgery, Budapest, Hungary
| | - László Halász
- National Institute of Mental Health, Neurology and Neurosurgery, Budapest, Hungary
| | - Loránd Erőss
- National Institute of Mental Health, Neurology and Neurosurgery, Budapest, Hungary
| | - Dániel Fabó
- National Institute of Mental Health, Neurology and Neurosurgery, Budapest, Hungary
| | - Róbert Bódizs
- Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
| |
Collapse
|
3
|
Venkatesh P, Wolfe C, Lega B. Neuromodulation of the anterior thalamus: Current approaches and opportunities for the future. CURRENT RESEARCH IN NEUROBIOLOGY 2023; 5:100109. [PMID: 38020810 PMCID: PMC10663132 DOI: 10.1016/j.crneur.2023.100109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 08/28/2023] [Accepted: 08/31/2023] [Indexed: 12/01/2023] Open
Abstract
The role of thalamocortical circuits in memory has driven a recent burst of scholarship, especially in animal models. Investigating this circuitry in humans is more challenging. And yet, the development of new recording and stimulation technologies deployed for clinical indications has created novel opportunities for data collection to elucidate the cognitive roles of thalamic structures. These technologies include stereoelectroencephalography (SEEG), deep brain stimulation (DBS), and responsive neurostimulation (RNS), all of which have been applied to memory-related thalamic regions, specifically for seizure localization and treatment. This review seeks to summarize the existing applications of neuromodulation of the anterior thalamic nuclei (ANT) and highlight several devices and their capabilities that can allow cognitive researchers to design experiments to assay its functionality. Our goal is to introduce to investigators, who may not be familiar with these clinical devices, the capabilities, and limitations of these tools for understanding the neurophysiology of the ANT as it pertains to memory and other behaviors. We also briefly cover the targeting of other thalamic regions including the centromedian (CM) nucleus, dorsomedial (DM) nucleus, and pulvinar, with associated potential avenues of experimentation.
Collapse
Affiliation(s)
- Pooja Venkatesh
- Department of Neurosurgery, University of Texas Southwestern, Dallas, TX, 75390, USA
| | - Cody Wolfe
- Department of Neurosurgery, University of Texas Southwestern, Dallas, TX, 75390, USA
| | - Bradley Lega
- Department of Neurosurgery, University of Texas Southwestern, Dallas, TX, 75390, USA
| | | |
Collapse
|
4
|
Fisher RS. Deep brain stimulation of thalamus for epilepsy. Neurobiol Dis 2023; 179:106045. [PMID: 36809846 DOI: 10.1016/j.nbd.2023.106045] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 02/10/2023] [Accepted: 02/13/2023] [Indexed: 02/22/2023] Open
Abstract
Neuromodulation (neurostimulation) is a relatively new and rapidly growing treatment for refractory epilepsy. Three varieties are approved in the US: vagus nerve stimulation (VNS), deep brain stimulation (DBS) and responsive neurostimulation (RNS). This article reviews thalamic DBS for epilepsy. Among many thalamic sub-nuclei, DBS for epilepsy has been targeted to the anterior nucleus (ANT), centromedian nucleus (CM), dorsomedial nucleus (DM) and pulvinar (PULV). Only ANT is FDA-approved, based upon a controlled clinical trial. Bilateral stimulation of ANT reduced seizures by 40.5% at three months in the controlled phase (p = .038) and 75% by 5 years in the uncontrolled phase. Side effects related to paresthesias, acute hemorrhage, infection, occasional increased seizures, and usually transient effects on mood and memory. Efficacy was best documented for focal onset seizures in temporal or frontal lobe. CM stimulation may be useful for generalized or multifocal seizures and PULV for posterior limbic seizures. Mechanisms of DBS for epilepsy are largely unknown, but animal work points to changes in receptors, channels, neurotransmitters, synapses, network connectivity and neurogenesis. Personalization of therapies, in terms of connectivity of the seizure onset zone to the thalamic sub- nucleus and individual characteristics of the seizures, might lead to improved efficacy. Many questions remain about DBS, including the best candidates for different types of neuromodulation, the best targets, the best stimulation parameters, how to minimize side effects and how to deliver current noninvasively. Despite the questions, neuromodulation provides useful new opportunities to treat people with refractory seizures not responding to medicines and not amenable to resective surgery.
Collapse
Affiliation(s)
- Robert S Fisher
- Department of Neurology and Neurological Sciences and Neurosurgery by Courtesy, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, 213 Quarry Road, Room 4865, Palo Alto, CA 94304, USA.
| |
Collapse
|
5
|
Yan H, Wang X, Yu T, Ni D, Qiao L, Zhang X, Xu C, Shu W, Wang Y, Ren L. The anterior nucleus of the thalamus plays a role in the epileptic network. Ann Clin Transl Neurol 2022; 9:2010-2024. [PMID: 36334281 PMCID: PMC9735375 DOI: 10.1002/acn3.51693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/10/2022] [Accepted: 10/24/2022] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES We investigated both the metabolic differences and interictal/ictal discharges of the anterior nucleus of the thalamus (ANT) in patients with epilepsy to clarify the relationship between the ANT and the epileptic network. METHODS Nineteen patients with drug-resistant epilepsy who underwent stereoelectroencephalography were studied. Metabolic differences in ANT were analyzed using [18F] fluorodeoxyglucose-positron emission tomography with three-dimensional (3D) visual and quantitative analyses. Interictal and ictal discharges in the ANT were analyzed using visual and time-frequency analyses. The relationship between interictal discharge and metabolic differences was analyzed. RESULTS We found that patients with temporal lobe epilepsy (TLE) showed significant metabolic differences in bilateral ANT compared with extratemporal lobe epilepsy in 3D visual and quantitative analyses. Four types of interictal activities were recorded from the ANT: spike, high-frequency oscillation (HFO), slow-wave, and α-rhythmic activity. Spike and HFO waveforms were recorded mainly in patients with TLE. Two spike patterns were recorded: synchronous and independent. In 83.3% of patients, ANT was involved during seizures. Three seizure onset types of ANT were recorded: low-voltage fast activity, rhythmic spikes, and theta band discharge. The time interval of seizure onset between the seizure onset zone and ANT showed two patterns: immediate and delayed. INTERPRETATION ANT can receive either interictal discharges or ictal discharges which propagate from the epileptogenic zones. Independent epileptic discharges can also be recorded from the ANT in some patients. Metabolic anomalies and epileptic discharges in the ANT indicate that the ANT plays a role in the epileptic network in most patients with epilepsy, especially TLE.
Collapse
Affiliation(s)
- Hao Yan
- Department of Functional NeurosurgeryBeijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical UniversityBeijingChina
| | - Xueyuan Wang
- Department of Functional NeurosurgeryBeijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical UniversityBeijingChina
| | - Tao Yu
- Department of Functional NeurosurgeryBeijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical UniversityBeijingChina
| | - Duanyu Ni
- Department of Functional NeurosurgeryBeijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical UniversityBeijingChina
| | - Liang Qiao
- Department of Functional NeurosurgeryBeijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical UniversityBeijingChina
| | - Xiaohua Zhang
- Department of Functional NeurosurgeryBeijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical UniversityBeijingChina
| | - Cuiping Xu
- Department of Functional NeurosurgeryBeijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical UniversityBeijingChina
| | - Wei Shu
- Department of Functional NeurosurgeryBeijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical UniversityBeijingChina
| | - Yuping Wang
- Department of Neurology, Comprehensive Epilepsy Center of Beijing, Beijing Key Laboratory of NeuromodulationXuanwu Hospital, Capital Medical UniversityBeijingChina
| | - Liankun Ren
- Department of Neurology, Comprehensive Epilepsy Center of Beijing, Beijing Key Laboratory of NeuromodulationXuanwu Hospital, Capital Medical UniversityBeijingChina
| |
Collapse
|
6
|
Gadot R, Korst G, Shofty B, Gavvala JR, Sheth SA. Thalamic stereoelectroencephalography in epilepsy surgery: a scoping literature review. J Neurosurg 2022; 137:1210-1225. [PMID: 35276641 DOI: 10.3171/2022.1.jns212613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 01/10/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Stereoelectroencephalography (sEEG) is a well-established surgical method for defining the epileptogenic network. Traditionally reserved for identifying discrete cortical regions for resection or ablation, sEEG in current practice is also used for identifying more broadly involved subcortical epileptic network components, driven by the availability of brain-based neuromodulation strategies. In particular, sEEG investigations including thalamic nuclei are becoming more frequent in parallel with the increase in therapeutic strategies involving thalamic targets such as deep brain stimulation (DBS) and responsive neurostimulation (RNS). The objective to this study was to evaluate existing evidence and trends regarding the purpose, techniques, and relevant electrographic findings of thalamic sEEG. METHODS MEDLINE and Embase databases were systematically queried for eligible peer-reviewed studies involving sEEG electrode implantation into thalamic nuclei of patients with epilepsy. Available data were abstracted concerning preoperative workup and purpose for implanting the thalamus, thalamic targets and trajectories, and electrophysiological methodology and findings. RESULTS sEEG investigations have included thalamic targets for both basic and clinical research purposes. Medial pulvinar, dorsomedial, anterior, and centromedian nuclei have been the most frequently studied. Few studies have reported any complications with thalamic sEEG implantation, and no studies have reported long-term complications. Various methods have been utilized to characterize thalamic activity in epileptic disorders including evoked potentials, power spectrograms, synchronization indices, and the epileptogenicity index. Thalamic intracranial recordings are beginning to be used to guide neuromodulation strategies including RNS and DBS, as well as to understand complex, network-dependent seizure disorders. CONCLUSIONS Inclusion of thalamic coverage during sEEG evaluation in drug-resistant epilepsy is a growing practice and is amenable to various methods of electrographic data analysis. Further study is required to establish well-defined criteria for thalamic implantation during invasive investigations as well as safety and ethical considerations.
Collapse
Affiliation(s)
| | | | | | - Jay R Gavvala
- 2Neurology, Baylor College of Medicine, Houston, Texas
| | | |
Collapse
|
7
|
Knipper M, Singer W, Schwabe K, Hagberg GE, Li Hegner Y, Rüttiger L, Braun C, Land R. Disturbed Balance of Inhibitory Signaling Links Hearing Loss and Cognition. Front Neural Circuits 2022; 15:785603. [PMID: 35069123 PMCID: PMC8770933 DOI: 10.3389/fncir.2021.785603] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/08/2021] [Indexed: 12/19/2022] Open
Abstract
Neuronal hyperexcitability in the central auditory pathway linked to reduced inhibitory activity is associated with numerous forms of hearing loss, including noise damage, age-dependent hearing loss, and deafness, as well as tinnitus or auditory processing deficits in autism spectrum disorder (ASD). In most cases, the reduced central inhibitory activity and the accompanying hyperexcitability are interpreted as an active compensatory response to the absence of synaptic activity, linked to increased central neural gain control (increased output activity relative to reduced input). We here suggest that hyperexcitability also could be related to an immaturity or impairment of tonic inhibitory strength that typically develops in an activity-dependent process in the ascending auditory pathway with auditory experience. In these cases, high-SR auditory nerve fibers, which are critical for the shortest latencies and lowest sound thresholds, may have either not matured (possibly in congenital deafness or autism) or are dysfunctional (possibly after sudden, stressful auditory trauma or age-dependent hearing loss linked with cognitive decline). Fast auditory processing deficits can occur despite maintained basal hearing. In that case, tonic inhibitory strength is reduced in ascending auditory nuclei, and fast inhibitory parvalbumin positive interneuron (PV-IN) dendrites are diminished in auditory and frontal brain regions. This leads to deficits in central neural gain control linked to hippocampal LTP/LTD deficiencies, cognitive deficits, and unbalanced extra-hypothalamic stress control. Under these conditions, a diminished inhibitory strength may weaken local neuronal coupling to homeostatic vascular responses required for the metabolic support of auditory adjustment processes. We emphasize the need to distinguish these two states of excitatory/inhibitory imbalance in hearing disorders: (i) Under conditions of preserved fast auditory processing and sustained tonic inhibitory strength, an excitatory/inhibitory imbalance following auditory deprivation can maintain precise hearing through a memory linked, transient disinhibition that leads to enhanced spiking fidelity (central neural gain⇑) (ii) Under conditions of critically diminished fast auditory processing and reduced tonic inhibitory strength, hyperexcitability can be part of an increased synchronization over a broader frequency range, linked to reduced spiking reliability (central neural gain⇓). This latter stage mutually reinforces diminished metabolic support for auditory adjustment processes, increasing the risks for canonical dementia syndromes.
Collapse
Affiliation(s)
- Marlies Knipper
- Department of Otolaryngology, Head and Neck Surgery, Tübingen Hearing Research Center (THRC), Molecular Physiology of Hearing, University of Tübingen, Tübingen, Germany
- *Correspondence: Marlies Knipper,
| | - Wibke Singer
- Department of Otolaryngology, Head and Neck Surgery, Tübingen Hearing Research Center (THRC), Molecular Physiology of Hearing, University of Tübingen, Tübingen, Germany
| | - Kerstin Schwabe
- Experimental Neurosurgery, Department of Neurosurgery, Hannover Medical School, Hanover, Germany
| | - Gisela E. Hagberg
- Department of Biomedical Magnetic Resonance, University Hospital Tübingen (UKT), Tübingen, Germany
- High-Field Magnetic Resonance, Max Planck Institute for Biological Cybernetics, Tübingen, Germany
| | - Yiwen Li Hegner
- MEG Center, University of Tübingen, Tübingen, Germany
- Center of Neurology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Lukas Rüttiger
- Department of Otolaryngology, Head and Neck Surgery, Tübingen Hearing Research Center (THRC), Molecular Physiology of Hearing, University of Tübingen, Tübingen, Germany
| | - Christoph Braun
- MEG Center, University of Tübingen, Tübingen, Germany
- Center of Neurology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Rüdiger Land
- Department of Experimental Otology, Institute for Audioneurotechnology, Hannover Medical School, Hanover, Germany
| |
Collapse
|
8
|
Chan HY, Wijnen BFM, Majoie MHJM, Evers SMAA, Hiligsmann M. Economic evaluation of deep brain stimulation compared with vagus nerve stimulation and usual care for patients with refractory epilepsy: A lifetime decision analytic model. Epilepsia 2021; 63:641-651. [PMID: 34967942 PMCID: PMC9306584 DOI: 10.1111/epi.17158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 12/17/2021] [Accepted: 12/17/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study was undertaken to estimate the cost-effectiveness of deep brain stimulation (DBS) compared with vagus nerve stimulation (VNS) and care as usual (CAU) for adult patients with refractory epilepsy from a health care perspective using a lifetime decision analytic model. METHODS A Markov decision analytic model was constructed to estimate the lifetime cost-effectiveness of DBS compared with VNS and CAU. Transition probabilities were estimated from a randomized controlled trial, and assumptions were made in consensus with an expert panel. Primary outcomes were expressed as incremental costs per quality-adjusted life-year (QALY) and per responder. Univariate and probabilistic sensitivity analyses were conducted to characterize parameter uncertainty. RESULTS In DBS, 28.4% of the patients were responders, with an average of 21.38 QALYs per patient and expected lifetime health care costs of €187 791. VNS had fewer responders (22.3%), fewer QALYs (20.70), and lower lifetime costs (€156 871). CAU had the fewest responders (6.2%), fewest QALYs (18.74), and lowest total health care costs (€64 670). When comparing with CAU, incremental cost-effectiveness ratios (ICERs) showed that costs per QALY gained were slightly lower for DBS (€46 640) than for VNS (€47 155). When comparing DBS with VNS, an incremental cost per additional QALY gained of €45 170 was found for DBS. Sensitivity analyses showed that ICERs were heavily dependent on assumptions regarding loss to follow-up in the respective clinical trial. SIGNIFICANCE This study suggests that, given current limited evidence, VNS and DBS are potentially cost-effective treatment strategies compared to CAU for patients with refractory epilepsy. However, results for DBS were heavily impacted by assumptions made to extrapolate nonresponse from the original trial. More stringent assumptions regarding nonresponse resulted in an ICER just above an acceptable willingness to pay threshold. Given the uncertainty surrounding the effectiveness of DBS and the large impact of assumptions related to nonresponse, further empirical research is needed to reduce uncertainty.
Collapse
Affiliation(s)
- Hoi Yau Chan
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Ben F M Wijnen
- Center for Economic Evaluation and Machine Learning, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands.,Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Marian H J M Majoie
- Department of Research and Development, Epilepsy Center Kempenhaeghe, Heeze, the Netherlands.,Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands.,School of Health Professions Education, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, the Netherlands.,Department of Neurology, Academic Center for Epileptology, Epilepsy Center Kempenhaeghe and Maastricht University Medical Center, Maastricht, the Netherlands
| | - Silvia M A A Evers
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands.,Center for Economic Evaluation and Machine Learning, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands
| | - Mickaël Hiligsmann
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| |
Collapse
|
9
|
Ákos Szabó C, De La Garza M, Shade R, Papanastassiou AM, Nathanielsz P. Cortical responsive neurostimulation in a baboon with genetic generalized epilepsy. Epilepsy Behav 2021; 120:107973. [PMID: 33962250 PMCID: PMC8483259 DOI: 10.1016/j.yebeh.2021.107973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/25/2021] [Accepted: 04/01/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate the efficacy of cortical responsive neurostimulation (CRN) in a male baboon with epilepsy and with genetic generalized epilepsy (GGE), as well as the alteration of seizure patterns and their circadian rhythms due to treatment. METHODS The baboon was implanted with two subdural frontoparietal strips, bridging the medial central sulci bilaterally. Electrocorticography (ECoG) data were downloaded daily during a three-month baseline, then every 2-3 days over a five-month treatment period. Long episodes, reflecting ictal or interictal epileptic discharges, were also quantified. RESULTS Twenty-three generalized tonic-clonic seizures (GTCS) and 2 episodes of nonconvulsive status epilepticus (NCSE) were recorded at baseline (median 8 events/month), whereas 26 GTCS were recorded under treatment (median 5/month). Similarly, daily indices of long episodes decreased from 0.46 at baseline to 0.29 with treatment. Ictal ECoG patterns and the circadian distribution of GTCS were also altered by RNS therapy. SIGNIFICANCE This case study provides the proof-of-concept for RNS therapy in the baboon model of GGE. Cortical responsive neurostimulation (CRN) demonstrated a 38% median reduction in GTCS. Distinct ictal patterns were identified, which changed over the treatment period; the circadian pattern of his GTCS also shifted gradually from night to daytime with treatment. Future studies targeting the thalamic nuclei, or combining cortical and subcortical sites, may further improve detection and control of GTCS as well as other generalized seizure types. More broadly, this study demonstrates opportunities for evaluating seizure detection as well as chronic therapeutic interventions over long term in the baboon.
Collapse
Affiliation(s)
- C. Ákos Szabó
- Department of Neurology, UT Health San Antonio, San Antonio, Texas
| | - Melissa De La Garza
- Southwest National Primate Research Center, Texas Biomedical Research Institute, San Antonio, Texas
| | - Robert Shade
- Southwest National Primate Research Center, Texas Biomedical Research Institute, San Antonio, Texas
| | | | - Peter Nathanielsz
- Southwest National Primate Research Center, Texas Biomedical Research Institute, San Antonio, Texas,Department of Animal Science, University of Wyoming, Laramie, WY
| |
Collapse
|
10
|
Deutschová B, Klimeš P, Jordan Z, Jurák P, Erőss L, Lamoš M, Halámek J, Daniel P, Rektor I, Fabo D. Thalamic oscillatory activity may predict response to deep brain stimulation of the anterior nuclei of the thalamus. Epilepsia 2021; 62:e70-e75. [PMID: 33755992 DOI: 10.1111/epi.16883] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 03/03/2021] [Accepted: 03/03/2021] [Indexed: 11/30/2022]
Abstract
We hypothesized that local/regional properties of stimulated structure/circuitry contribute to the effect of deep brain stimulation (DBS). We analyzed intracerebral electroencephalographic (EEG) recordings from externalized DBS electrodes targeted bilaterally in the anterior nuclei of the thalamus (ANT) in 12 patients (six responders, six nonresponders) with more than 1 year of follow-up care. In the bipolar local field potentials of the EEG, spectral power (PW) and power spectral entropy (PSE) were calculated in the passbands 1-4, 4-8, 8-12, 12-20, 20-45, 65-80, 80-200 and 200-500 Hz. The most significant differences between responders and nonresponders were observed in the BRIDGE area (bipolar recordings with one contact within the ANT and the second contact in adjacent tissue). In responders, PW was significantly decreased in the frequency bands of 65-80, 80-200, and 200-500 Hz (p < .05); PSE was significantly increased in all frequency bands (p < .05) except for 200-500 Hz (p = .06). The local EEG characteristics of ANT recorded after implantation may play a significant role in DBS response prediction.
Collapse
Affiliation(s)
- Barbora Deutschová
- Brno Epilepsy Center, Department of Neurology, St. Anne's University Hospital and the Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Multimodal and Functional Neuroimaging Research Group, Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Petr Klimeš
- Institute of Scientific Instruments of the Czech Academy of Sciences, Brno, Czech Republic
| | - Zsofia Jordan
- Epilepsy Center, Department of Neurology, National Institute of Clinical Neurosciences, Budapest, Hungary
| | - Pavel Jurák
- Institute of Scientific Instruments of the Czech Academy of Sciences, Brno, Czech Republic
| | - Lorand Erőss
- Epilepsy Center, Department of Neurology, National Institute of Clinical Neurosciences, Budapest, Hungary
| | - Martin Lamoš
- Multimodal and Functional Neuroimaging Research Group, Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Josef Halámek
- Institute of Scientific Instruments of the Czech Academy of Sciences, Brno, Czech Republic
| | - Pavel Daniel
- Brno Epilepsy Center, Department of Neurology, St. Anne's University Hospital and the Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Multimodal and Functional Neuroimaging Research Group, Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Ivan Rektor
- Brno Epilepsy Center, Department of Neurology, St. Anne's University Hospital and the Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Multimodal and Functional Neuroimaging Research Group, Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Daniel Fabo
- Epilepsy Center, Department of Neurology, National Institute of Clinical Neurosciences, Budapest, Hungary
| |
Collapse
|
11
|
Sweeney-Reed CM, Buentjen L, Voges J, Schmitt FC, Zaehle T, Kam JWY, Kaufmann J, Heinze HJ, Hinrichs H, Knight RT, Rugg MD. The role of the anterior nuclei of the thalamus in human memory processing. Neurosci Biobehav Rev 2021; 126:146-158. [PMID: 33737103 DOI: 10.1016/j.neubiorev.2021.02.046] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 02/19/2021] [Accepted: 02/24/2021] [Indexed: 12/13/2022]
Abstract
Extensive neuroanatomical connectivity between the anterior thalamic nuclei (ATN) and hippocampus and neocortex renders them well-placed for a role in memory processing, and animal, lesion, and neuroimaging studies support such a notion. The deep location and small size of the ATN have precluded their real-time electrophysiological investigation during human memory processing. However, ATN electrophysiological recordings from patients receiving electrodes implanted for deep brain stimulation for pharmacoresistant focal epilepsy have enabled high temporal resolution study of ATN activity. Theta frequency synchronization of ATN and neocortical oscillations during successful memory encoding, enhanced phase alignment, and coupling between ATN local gamma frequency activity and frontal neocortical and ATN theta oscillations provide evidence of an active role for the ATN in memory encoding, potentially integrating information from widespread neocortical sources. Greater coupling of a broader gamma frequency range with theta oscillations at rest than during memory encoding provides additional support for the hypothesis that the ATN play a role in selecting local, task-relevant high frequency activity associated with particular features of a memory trace.
Collapse
Affiliation(s)
- Catherine M Sweeney-Reed
- Neurocybernetics and Rehabilitation, Dept. of Neurology, Otto-von-Guericke University Magdeburg, Leipziger Straße 44, 39120, Magdeburg, Germany; Center for Behavioral Brain Sciences, Otto-von-Guericke University, Magdeburg, Germany.
| | - Lars Buentjen
- Dept. of Stereotactic Neurosurgery, Otto-von-Guericke University, Magdeburg, Germany
| | - Jürgen Voges
- Center for Behavioral Brain Sciences, Otto-von-Guericke University, Magdeburg, Germany; Dept. of Stereotactic Neurosurgery, Otto-von-Guericke University, Magdeburg, Germany
| | | | - Tino Zaehle
- Center for Behavioral Brain Sciences, Otto-von-Guericke University, Magdeburg, Germany; Dept. of Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - Julia W Y Kam
- Department of Psychology, University of Calgary, Calgary, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Canada; Helen Wills Neuroscience Institute, University of California - Berkeley, Berkeley, CA, USA
| | - Jörn Kaufmann
- Dept. of Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - Hans-Jochen Heinze
- Center for Behavioral Brain Sciences, Otto-von-Guericke University, Magdeburg, Germany; Dept. of Neurology, Otto-von-Guericke University, Magdeburg, Germany; Dept. of Behavioral Neurology, Leibniz Institute for Neurobiology, Magdeburg, Germany
| | - Hermann Hinrichs
- Center for Behavioral Brain Sciences, Otto-von-Guericke University, Magdeburg, Germany; Dept. of Neurology, Otto-von-Guericke University, Magdeburg, Germany; Dept. of Behavioral Neurology, Leibniz Institute for Neurobiology, Magdeburg, Germany
| | - Robert T Knight
- Helen Wills Neuroscience Institute, University of California - Berkeley, Berkeley, CA, USA; Department of Psychology, University of California, Berkeley, Berkeley, CA, USA
| | - Michael D Rugg
- Center for Vital Longevity and School of Behavioral and Brain Sciences, University of Texas, Dallas, TX, USA
| |
Collapse
|
12
|
Thuberg D, Buentjen L, Holtkamp M, Voges J, Heinze HJ, Lee H, Kitay AY, Schmitt FC. Deep Brain Stimulation for Refractory Focal Epilepsy: Unraveling the Insertional Effect up to Five Months Without Stimulation. Neuromodulation 2021; 24:373-379. [PMID: 33577139 DOI: 10.1111/ner.13349] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 10/29/2020] [Accepted: 12/04/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Following electrode implantation, a subgroup of patients treated with deep brain stimulation (DBS) for focal epilepsy exhibits a reduction of seizure frequency before stimulation is initiated. Microlesioning of the target structure has been postulated to be the cause of this "insertional" effect (IE). We examined the occurrence and duration of this IE in a group of patients with focal epilepsy following electrode implantation in the anterior nuclei of the thalamus (ANT) and/or nucleus accumbens (NAC) for DBS treatment. MATERIALS AND METHODS Changes in monthly seizure frequency compared to preoperative baseline were assessed one month (14 patients) and five months (four patients) after electrode implantation. A group analysis between patients with implantation of bilateral ANT-electrodes (four patients), NAC-electrodes (one patient) as well as ANT and NAC-electrodes (nine patients) was performed. RESULTS In this cohort, seizure frequency decreased one month after electrode implantation by 57.1 ± 30.1%, p ≤ 0.001 (compared to baseline). No significant difference within stimulation target subcohorts was found (p > 0.05). Out of the four patients without stimulation for five months following electrode insertion, three patients showed seizure frequency reduction lasting two to three months, while blinded to their stimulation status. CONCLUSION An IE might explain seizure frequency reduction in our cohort. This effect seems to be independent of the number of implanted electrodes and of the target itself. The time course of the blinded subgroup of epilepsy patients suggests a peak of the lesional effect at two to three months after electrode insertion.
Collapse
Affiliation(s)
- Dominik Thuberg
- Department of Neurology, University of Magdeburg, Magdeburg, Germany
| | - Lars Buentjen
- Department of Stereotactic Neurosurgery, University of Magdeburg, Magdeburg, Germany
| | - Martin Holtkamp
- Epilepsy-Center Berlin-Brandenburg, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jürgen Voges
- Department of Stereotactic Neurosurgery, University of Magdeburg, Magdeburg, Germany.,Leibniz Institute for Neurobiology (LIN), Magdeburg, Germany
| | - Hans-Jochen Heinze
- Department of Neurology, University of Magdeburg, Magdeburg, Germany.,Leibniz Institute for Neurobiology (LIN), Magdeburg, Germany
| | - Harim Lee
- Department of Neurology, University of Magdeburg, Magdeburg, Germany
| | - Ann-Yasmin Kitay
- Department of Neurology, University of Magdeburg, Magdeburg, Germany
| | | |
Collapse
|
13
|
Schaper FLWVJ, Plantinga BR, Colon AJ, Wagner GL, Boon P, Blom N, Gommer ED, Hoogland G, Ackermans L, Rouhl RPW, Temel Y. Deep Brain Stimulation in Epilepsy: A Role for Modulation of the Mammillothalamic Tract in Seizure Control? Neurosurgery 2021; 87:602-610. [PMID: 32421806 PMCID: PMC8210468 DOI: 10.1093/neuros/nyaa141] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 02/16/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Deep brain stimulation of the anterior nucleus of the thalamus (ANT-DBS) can improve seizure control for patients with drug-resistant epilepsy (DRE). Yet, one cannot overlook the high discrepancy in efficacy among patients, possibly resulting from differences in stimulation site. OBJECTIVE To test the hypothesis that stimulation at the junction of the ANT and mammillothalamic tract (ANT-MTT junction) increases seizure control. METHODS The relationship between seizure control and the location of the active contacts to the ANT-MTT junction was investigated in 20 patients treated with ANT-DBS for DRE. Coordinates and Euclidean distance of the active contacts relative to the ANT-MTT junction were calculated and related to seizure control. Stimulation sites were mapped by modelling the volume of tissue activation (VTA) and generating stimulation heat maps. RESULTS After 1 yr of stimulation, patients had a median 46% reduction in total seizure frequency, 50% were responders, and 20% of patients were seizure-free. The Euclidean distance of the active contacts to the ANT-MTT junction correlates to change in seizure frequency (r2 = 0.24, P = .01) and is ∼30% smaller (P = .015) in responders than in non-responders. VTA models and stimulation heat maps indicate a hot-spot at the ANT-MTT junction for responders, whereas non-responders had no evident hot-spot. CONCLUSION Stimulation at the ANT-MTT junction correlates to increased seizure control. Our findings suggest a relationship between the stimulation site and therapy response in ANT-DBS for epilepsy with a potential role for the MTT. DBS directed at white matter merits further exploration for the treatment of epilepsy.
Collapse
Affiliation(s)
- Frédéric L W V J Schaper
- Department of Neurology, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.,Department of Neurosurgery, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.,School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands
| | - Birgit R Plantinga
- Department of Neurosurgery, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.,School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands
| | - Albert J Colon
- Academic Center for Epileptology Kempenhaeghe/ Maastricht University Medical Center, Heeze, The Netherlands.,Academic Center for Epileptology Kempenhaeghe/ Maastricht University Medical Center, Maastricht, The Netherlands
| | - G Louis Wagner
- Academic Center for Epileptology Kempenhaeghe/ Maastricht University Medical Center, Heeze, The Netherlands.,Academic Center for Epileptology Kempenhaeghe/ Maastricht University Medical Center, Maastricht, The Netherlands
| | - Paul Boon
- Academic Center for Epileptology Kempenhaeghe/ Maastricht University Medical Center, Heeze, The Netherlands.,Academic Center for Epileptology Kempenhaeghe/ Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Neurology, University Hospital Ghent, Ghent, Belgium
| | - Nadia Blom
- Department of Neurosurgery, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.,School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands
| | - Erik D Gommer
- Department of Clinical Neurophysiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Govert Hoogland
- Department of Neurosurgery, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.,School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands.,Academic Center for Epileptology Kempenhaeghe/ Maastricht University Medical Center, Maastricht, The Netherlands
| | - Linda Ackermans
- Department of Neurosurgery, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Rob P W Rouhl
- Department of Neurology, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.,School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands.,Academic Center for Epileptology Kempenhaeghe/ Maastricht University Medical Center, Maastricht, The Netherlands
| | - Yasin Temel
- Department of Neurosurgery, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.,School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
14
|
Zhou JJ, Chen T, Farber SH, Shetter AG, Ponce FA. Open-loop deep brain stimulation for the treatment of epilepsy: a systematic review of clinical outcomes over the past decade (2008-present). Neurosurg Focus 2019; 45:E5. [PMID: 30064324 DOI: 10.3171/2018.5.focus18161] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE The field of deep brain stimulation (DBS) for epilepsy has grown tremendously since its inception in the 1970s and 1980s. The goal of this review is to identify and evaluate all studies published on the topic of open-loop DBS for epilepsy over the past decade (2008 to present). METHODS A PubMed search was conducted to identify all articles reporting clinical outcomes of open-loop DBS for the treatment of epilepsy published since January 1, 2008. The following composite search terms were used: ("epilepsy" [MeSH] OR "seizures" [MeSH] OR "kindling, neurologic" [MeSH] OR epilep* OR seizure* OR convuls*) AND ("deep brain stimulation" [MeSH] OR "deep brain stimulation" OR "DBS") OR ("electric stimulation therapy" [MeSH] OR "electric stimulation therapy" OR "implantable neurostimulators" [MeSH]). RESULTS The authors identified 41 studies that met the criteria for inclusion. The anterior nucleus of the thalamus, centromedian nucleus of the thalamus, and hippocampus were the most frequently evaluated targets. Among the 41 articles, 19 reported on stimulation of the anterior nucleus of the thalamus, 6 evaluated stimulation of the centromedian nucleus of the thalamus, and 9 evaluated stimulation of the hippocampus. The remaining 7 articles reported on the evaluation of alternative DBS targets, including the posterior hypothalamus, subthalamic nucleus, ventral intermediate nucleus of the thalamus, nucleus accumbens, caudal zone incerta, mammillothalamic tract, and fornix. The authors evaluated each study for overall epilepsy response rates as well as adverse events and other significant, nonepilepsy outcomes. CONCLUSIONS Level I evidence supports the safety and efficacy of stimulating the anterior nucleus of the thalamus and the hippocampus for the treatment of medically refractory epilepsy. Level III and IV evidence supports stimulation of other targets for epilepsy. Ongoing research into the efficacy, adverse effects, and mechanisms of open-loop DBS continues to expand the knowledge supporting the use of these treatment modalities in patients with refractory epilepsy.
Collapse
|
15
|
Chen C, Li H, Ding F, Yang L, Huang P, Wang S, Jin B, Xu C, Wang Y, Ding M, Chen Z, Wang S. Alterations in the hippocampal-thalamic pathway underlying secondarily generalized tonic-clonic seizures in mesial temporal lobe epilepsy: A diffusion tensor imaging study. Epilepsia 2018; 60:121-130. [PMID: 30478929 DOI: 10.1111/epi.14614] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 11/05/2018] [Accepted: 11/05/2018] [Indexed: 12/31/2022]
Affiliation(s)
- Cong Chen
- Department of Neurology; Epilepsy Center; Second Affiliated Hospital; School of Medicine; Zhejiang University; Hangzhou China
| | - Hong Li
- Department of Radiology; Second Affiliated Hospital; School of Medicine; Zhejiang University; Hangzhou China
| | - Fang Ding
- Department of Neurology; Epilepsy Center; Second Affiliated Hospital; School of Medicine; Zhejiang University; Hangzhou China
| | - Linglin Yang
- Department of Neurology; Epilepsy Center; Second Affiliated Hospital; School of Medicine; Zhejiang University; Hangzhou China
| | - Peiyu Huang
- Department of Radiology; Second Affiliated Hospital; School of Medicine; Zhejiang University; Hangzhou China
| | - Shan Wang
- Department of Neurology; Epilepsy Center; Second Affiliated Hospital; School of Medicine; Zhejiang University; Hangzhou China
| | - Bo Jin
- Department of Neurology; Epilepsy Center; Second Affiliated Hospital; School of Medicine; Zhejiang University; Hangzhou China
| | - Cenglin Xu
- Key Laboratory of Medical Neurobiology of the Ministry of Health of China; Zhejiang Province Key Laboratory of Neurobiology; Department of Pharmacology; College of Pharmaceutical Sciences; Zhejiang University; Hangzhou China
| | - Yi Wang
- Key Laboratory of Medical Neurobiology of the Ministry of Health of China; Zhejiang Province Key Laboratory of Neurobiology; Department of Pharmacology; College of Pharmaceutical Sciences; Zhejiang University; Hangzhou China
| | - Meiping Ding
- Department of Neurology; Epilepsy Center; Second Affiliated Hospital; School of Medicine; Zhejiang University; Hangzhou China
| | - Zhong Chen
- Department of Neurology; Epilepsy Center; Second Affiliated Hospital; School of Medicine; Zhejiang University; Hangzhou China
- Key Laboratory of Medical Neurobiology of the Ministry of Health of China; Zhejiang Province Key Laboratory of Neurobiology; Department of Pharmacology; College of Pharmaceutical Sciences; Zhejiang University; Hangzhou China
| | - Shuang Wang
- Department of Neurology; Epilepsy Center; Second Affiliated Hospital; School of Medicine; Zhejiang University; Hangzhou China
| |
Collapse
|
16
|
Sitnikov AR, Grigoryan YA, Mishnyakova LP. Bilateral stereotactic lesions and chronic stimulation of the anterior thalamic nuclei for treatment of pharmacoresistant epilepsy. Surg Neurol Int 2018; 9:137. [PMID: 30105131 PMCID: PMC6069370 DOI: 10.4103/sni.sni_25_18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Accepted: 06/21/2018] [Indexed: 12/18/2022] Open
Abstract
Background: The use of the anterior nucleus of thalamus (ANT) as a target for treatment of pharmacoresistant epilepsy is based on its crucial role in seizure propagation. We describe results of chronic bilateral ANT stimulation and bilateral ANT lesions in 31 patients with refractory epilepsy. Methods: ANT DBS was performed in 12 patients (group I) and bilateral stereotactic radiofrequency lesions of ANT were performed in 19 patients (group II). Targeting was based on stereotactic atlas information with correction of the final coordinates according to the location of anatomical landmarks and intraoperative microelectrode recording data. Results: Both groups were similar in age, gender, seizures frequency, and duration of disease. The median x, y, and z coordinates of ANT were found to be 2.9, 5, and 11 mm anterior, lateral, and superior to the mid-commissural point, respectively. Mean seizures reduction reached 80.3% in group of patients with ANT DBS with two nonresponders and 91.2% in group of patients with lesions. Five patients from group I and three patients from group II became seizure-free. The morbidity rate was low in both groups. Conclusions: Stereotactic anterior thalamotomy and chronic ANT stimulation are both effective for seizure control in epilepsy originated from frontal and temporal lobes. ANT lesions and stimulation were more effective for secondary-generalized seizures compared to simple partial seizures.
Collapse
Affiliation(s)
- A R Sitnikov
- Federal Centre of Treatment and Rehabilitation of Ministry of Healthcare of Russian Federation, Ivankovskoe, Moscow, Russia
| | - Yu A Grigoryan
- Federal Centre of Treatment and Rehabilitation of Ministry of Healthcare of Russian Federation, Ivankovskoe, Moscow, Russia
| | - L P Mishnyakova
- Federal Centre of Treatment and Rehabilitation of Ministry of Healthcare of Russian Federation, Ivankovskoe, Moscow, Russia
| |
Collapse
|