DBS of thalamic centromedian nucleus for Lennox–Gastaut syndrome ( ESTEL trial)

2021 ◽  
Author(s):  
Linda J. Dalic ◽  
Aaron E.L Warren ◽  
Kristian J. Bulluss ◽  
Wesley Thevathasan ◽  
Annie Roten ◽  
...  
Keyword(s):  
Centromedian Nucleus

scholarly journals Open-loop deep brain stimulation for the treatment of epilepsy: a systematic review of clinical outcomes over the past decade (2008–present)

2018 ◽  
Vol 45 (2) ◽  
pp. E5 ◽  
Author(s):  
James J. Zhou ◽  
Tsinsue Chen ◽  
S. Harrison Farber ◽  
Andrew G. Shetter ◽  
Francisco A. Ponce
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Refractory Epilepsy ◽  
Open Loop ◽  
Electric Stimulation Therapy ◽  
Anterior Nucleus ◽  
The Past ◽  
Centromedian Nucleus ◽  
Deep Brain ◽  
Stimulation Of

OBJECTIVEThe 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).METHODSA 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]).RESULTSThe 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.CONCLUSIONSLevel 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.

The centromedian nucleus: Anatomy, physiology, and clinical implications

2019 ◽  
Vol 63 ◽  
pp. 1-7 ◽  
Author(s):  
Adeel Ilyas ◽  
Diana Pizarro ◽  
Andrew K. Romeo ◽  
Kristen O. Riley ◽  
Sandipan Pati
Keyword(s):  
Clinical Implications ◽  
Centromedian Nucleus

Gamma Knife surgery targeting the centromedian nucleus of the thalamus for the palliative management of thalamic pain: durable response in stroke-induced thalamic pain syndrome

2006 ◽  
Vol 105 (Supplement) ◽  
pp. 222-228 ◽  
Author(s):  
Marcus F. Keep ◽  
Lois Mastrofrancesco ◽  
Arthur D. Craig ◽  
Lynn S. Ashby
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Pain Syndrome ◽  
Physical Contact ◽  
Single Shot ◽  
Resonance Imaging ◽  
Durable Response ◽  
Centromedian Nucleus ◽  
Thalamic Pain Syndrome ◽  
Thalamic Pain

✓The authors report the neuroimaging features, treatment planning, and outcome in a case of radiosurgical thalamotomy targeting the centromedian nucleus (CMN) for stroke-induced thalamic pain.A 79-year-old man, with embolic occlusion of the left middle cerebral artery and large hemispheric infarction involving the thalamus, suffered a right hemiplegia and expressive aphasia. One year poststroke, severe right-sided facial, scalp, arm, and trunk pain developed and was exacerbated by any tactile contact. Medical treatment had failed. Medical illness, including mandatory anticoagulation therapy for atrial fibrillation, precluded surgical procedures. Minimally invasive radiosurgery was offered as an alternative. Magnetic resonance imaging and computed tomography were used to localize the left CMN. A single shot of 140 Gy was delivered to the 100% isodose line by using the 4-mm collimator helmet.The patient was evaluated at regular intervals. By 12 weeks posttreatment, he had significant improvements in pain control and his ability to tolerate physical contact during activities of daily living. Magnetic resonance imaging demonstrated baseline encephalomalacia from his prior stroke, and signal changes in the left CMN consistent with gamma irradiation–based thalamotomy. Currently, nearly 7 years after radiosurgery, he continues to enjoy a marked reduction in pain without the need of analgesic medications.Thalamic pain syndrome is generally refractory to conventional treatment. Neurosurgical interventions provide modest benefit and carry associated risks of invasive surgery and anesthesia. The CMN is readily localized with neuroimaging and is an approximate target to reduce the suffering aspect of pain. In this case, radiosurgery was a safe and effective treatment, providing durable symptom control and improved quality of life.

scholarly journals Brain-responsive corticothalamic stimulation in the centromedian nucleus for the treatment of regional neocortical epilepsy

2020 ◽  
Vol 112 ◽  
pp. 107354 ◽  
Author(s):  
David E. Burdette ◽  
M. Ayman Haykal ◽  
Beata Jarosiewicz ◽  
Rachel R. Fabris ◽  
Gabe Heredia ◽  
...  
Keyword(s):  
Centromedian Nucleus ◽  
Neocortical Epilepsy

Gamma knife surgery for refractory postherpetic trigeminal neuralgia: targeting in one session both the retrogasserian trigeminal nerve and the centromedian nucleus of the thalamus

2005 ◽  
Vol 102 (Special_Supplement) ◽  
pp. 276-282 ◽  
Author(s):  
Marcus F. Keep ◽  
Paul A. DeMare ◽  
Lynn S. Ashby
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Treatment Session ◽  
Single Treatment ◽  
Content Type ◽  
Centromedian Nucleus ◽  
Single Treatment Session ◽  
Fine Print

Object. The authors tested the hypothesis that two targets are needed to treat postherpetic trigeminal neuralgia (TN): one in the trigeminal nerve for the direct sharp pain and one in the thalamus for the diffuse burning pain. Methods. Three patients with refractory postherpetic TN were treated with gamma knife surgery (GKS) through a novel two-target approach. In a single treatment session, both the trigeminal nerve and centromedian nucleus were targeted. First, the trigeminal nerve, ipsilateral to the facial pain, was treated with 60 to 80 Gy. Second, the centromedian nucleus was localized using standard coordinates and by comparing magnetic resonance images with a stereotactic atlas. A single dose of 120 to 140 Gy was delivered to the target point with a single 4-mm isocenter. Patients were followed clinically and with neuroimaging studies. Pain relief was scored as excellent (75–100%), good (50–75%), poor (25–50%), or none (0–25%). Follow up ranged from 6 to 53 months. There were no GKS-related complications. Two patients died of unrelated medical illnesses but had good or excellent pain relief until death. One patient continues to survive with 44 months follow up and no decrease in pain intensity, but with a decreased area of pain. Conclusions. Combined GKS of the centromedian nucleus and trigeminal nerve in a single treatment session is feasible and safe, and the effect was promising. A larger study is required to confirm and expand these results.

Centromedian Nucleus and Epilepsy

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Francisco Velasco ◽  
Pablo Eduardo Saucedo-Alvarado ◽  
Azari Reichrath ◽  
Haydeé Valdés-Quiroz ◽  
Gustavo Aguado-Carrillo ◽  
...  
Keyword(s):  
Centromedian Nucleus
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