scholarly journals Seizure frequency reduction after posteromedial hypothalamus deep brain stimulation in drug-resistant epilepsy associated with intractable aggressive behavior

Epilepsia ◽  
2015 ◽  
Vol 56 (7) ◽  
pp. 1152-1161 ◽  
Author(s):  
Juan C. Benedetti-Isaac ◽  
Martin Torres-Zambrano ◽  
Andres Vargas-Toscano ◽  
Esther Perea-Castro ◽  
Gabriel Alcalá-Cerra ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Aggressive Behavior ◽  
Seizure Frequency ◽  
Brain Stimulation ◽  
Drug Resistant ◽  
Drug Resistant Epilepsy ◽  
Deep Brain

scholarly journals Deep brain stimulation of the anterior nucleus of the thalamus for drug-resistant epilepsy

2018 ◽  
Vol 42 (2) ◽  
pp. 287-296 ◽  
Author(s):  
Tim A. M. Bouwens van der Vlis ◽  
Olaf E. M. G. Schijns ◽  
Frédéric L. W. V. J. Schaper ◽  
Govert Hoogland ◽  
Pieter Kubben ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Drug Resistant ◽  
Anterior Nucleus ◽  
Drug Resistant Epilepsy ◽  
Deep Brain ◽  
Stimulation Of

scholarly journals Deep brain stimulation for drug-resistant epilepsy

Epilepsia ◽  
2017 ◽  
Vol 59 (2) ◽  
pp. 273-290 ◽  
Author(s):  
Michael C. H. Li ◽  
Mark J. Cook
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Drug Resistant ◽  
Drug Resistant Epilepsy ◽  
Deep Brain

scholarly journals Deep brain stimulation for seizure control in drug-resistant epilepsy

2018 ◽  
Vol 45 (2) ◽  
pp. E4 ◽  
Author(s):  
Neil Klinger ◽  
Sandeep Mittal
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Seizure Control ◽  
Effective Means ◽  
Drug Resistant ◽  
Thalamic Nuclei ◽  
Stimulation Parameters ◽  
Number Of Patients ◽  
Drug Resistant Epilepsy ◽  
Deep Brain

Antiepileptic drugs prevent morbidity and death in a large number of patients suffering from epilepsy. However, it is estimated that approximately 30% of epileptic patients will not have adequate seizure control with medication alone. Resection of epileptogenic cortex may be indicated in medically refractory cases with a discrete seizure focus in noneloquent cortex. For patients in whom resection is not an option, deep brain stimulation (DBS) may be an effective means of seizure control. Deep brain stimulation targets for treating seizures primarily include the thalamic nuclei, hippocampus, subthalamic nucleus, and cerebellum. A variety of stimulation parameters have been studied, and more recent advances in electrical stimulation to treat epilepsy include responsive neurostimulation. Data suggest that DBS is effective for treating drug-resistant epilepsy.

scholarly journals A systematic review of deep brain stimulation for the treatment of drug-resistant epilepsy in childhood

2019 ◽  
Vol 23 (3) ◽  
pp. 274-284 ◽  
Author(s):  
Han Yan ◽  
Eric Toyota ◽  
Melanie Anderson ◽  
Taylor J. Abel ◽  
Elizabeth Donner ◽  
...  
Keyword(s):  
Systematic Review ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Zona Incerta ◽  
Electrode Placement ◽  
Patient Specific ◽  
Seizure Freedom ◽  
Drug Resistant ◽  
Drug Resistant Epilepsy ◽  
Deep Brain

OBJECTIVEDrug-resistant epilepsy (DRE) presents a therapeutic challenge in children, necessitating the consideration of multiple treatment options. Although deep brain stimulation (DBS) has been studied in adults with DRE, little evidence is available to guide clinicians regarding the application of this potentially valuable tool in children. Here, the authors present the first systematic review aimed at understanding the safety and efficacy of DBS for DRE in pediatric populations, emphasizing patient selection, device placement and programming, and seizure outcomes.METHODSThe systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and recommendations. Relevant articles were identified from 3 electronic databases (MEDLINE, Embase, and Cochrane CENTRAL) from their inception to November 17, 2017. Inclusion criteria of individual studies were 1) diagnosis of DRE; 2) treatment with DBS; 3) inclusion of at least 1 pediatric patient (age ≤ 18 years); and 4) patient-specific data. Exclusion criteria for the systematic review included 1) missing data for age, DBS target, or seizure freedom; 2) nonhuman subjects; and 3) editorials, abstracts, review articles, and dissertations.RESULTSThis review identified 21 studies and 40 unique pediatric patients (ages 4–18 years) who received DBS treatment for epilepsy. There were 18 patients with electrodes placed in the bilateral or unilateral centromedian nucleus of the thalamus (CM) electrodes, 8 patients with bilateral anterior thalamic nucleus (ATN) electrodes, 5 patients with bilateral and unilateral hippocampal electrodes, 3 patients with bilateral subthalamic nucleus (STN) and 1 patient with unilateral STN electrodes, 2 patients with bilateral posteromedial hypothalamus electrodes, 2 patients with unilateral mammillothalamic tract electrodes, and 1 patient with caudal zona incerta electrode placement. Overall, 5 of the 40 (12.5%) patients had an International League Against Epilepsy class I (i.e., seizure-free) outcome, and 34 of the 40 (85%) patients had seizure reduction with DBS stimulation.CONCLUSIONSDBS is an alternative or adjuvant treatment for children with DRE. Prospective registries and future clinical trials are needed to identify the optimal DBS target, although favorable outcomes are reported with both CM and ATN in children.

Intracranial neuromodulation with deep brain stimulation and responsive neurostimulation in children with drug-resistant epilepsy: a systematic review

2021 ◽  
pp. 1-10
Author(s):  
Mehdi Khan ◽  
Jaber Paktiawal ◽  
Rory J. Piper ◽  
Aswin Chari ◽  
Martin M. Tisdall
Keyword(s):  
Systematic Review ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Risk Of Bias ◽  
Cochrane Library ◽  
Drug Resistant ◽  
Seizure Reduction ◽  
Drug Resistant Epilepsy ◽  
Deep Brain

OBJECTIVE In children with drug-resistant epilepsy (DRE), resective, ablative, and disconnective surgery may not be feasible or may fail. Neuromodulation in the form of deep brain stimulation (DBS) and responsive neurostimulation (RNS) may be viable treatment options, however evidence for their efficacies in children is currently limited. This systematic review aimed to summarize the literature on DBS and RNS for the treatment of DRE in the pediatric population. Specifically, the authors focused on currently available data for reported indications, neuromodulation targets, clinical efficacy, and safety outcomes. METHODS PRISMA guidelines were followed throughout this systematic review (PROSPERO no. CRD42020180669). Electronic databases, including PubMed, Embase, Cochrane Library, OpenGrey, and CINAHL Plus, were searched from their inception to February 19, 2021. Inclusion criteria were 1) studies with at least 1 pediatric patient (age < 19 years) who underwent DBS and/or RNS for DRE; and 2) retrospective, prospective, randomized, or nonrandomized controlled studies, case series, and case reports. Exclusion criteria were 1) letters, commentaries, conference abstracts, and reviews; and 2) studies without full text available. Risk of bias of the included studies was assessed using the Cochrane ROBINS-I (Risk of Bias in Non-randomised Studies - of Interventions) tool. RESULTS A total of 35 studies were selected that identified 72 and 46 patients who underwent DBS and RNS, respectively (age range 4–18 years). Various epilepsy etiologies and seizure types were described in both cohorts. Overall, 75% of patients had seizure reduction > 50% after DBS (among whom 6 were seizure free) at a median (range) follow-up of 14 (1–100) months. In an exploratory univariate analysis of factors associated with favorable response, the follow-up duration was shorter in those patients with a favorable response (18 vs 33 months, p < 0.05). In the RNS cohort, 73.2% of patients had seizure reduction > 50% after RNS at a median (range) follow-up of 22 (5–39) months. On closer inspection, 83.3% of patients who had > 50% reduction in seizures actually had > 75% reduction, with 4 patients being seizure free. CONCLUSIONS Overall, both DBS and RNS showed favorable response rates, indicating that both techniques should be considered for pediatric patients with DRE. However, serious risks of overall bias were found in all included studies. Many research needs in this area would be addressed by conducting high-quality clinical trials and establishing an international registry of patients who have undergone pediatric neuromodulation, thereby ensuring robust prospective collection of predictive variables and outcomes.

scholarly journals Defining the optimal target for anterior thalamic deep brain stimulation in patients with drug-refractory epilepsy

2020 ◽  
pp. 1-10 ◽  
Author(s):  
Wendy Guo ◽  
Bang-Bon Koo ◽  
Jae-Hun Kim ◽  
Rafeeque A. Bhadelia ◽  
Dae-Won Seo ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Refractory Epilepsy ◽  
Drug Resistant ◽  
Seizure Reduction ◽  
Optimal Target ◽  
Drug Resistant Epilepsy ◽  
Drug Refractory Epilepsy ◽  
Deep Brain

OBJECTIVEThe anterior thalamic nucleus (ATN) is a common target for deep brain stimulation (DBS) for the treatment of drug-refractory epilepsy. However, no atlas-based optimal DBS (active contacts) target within the ATN has been definitively identified. The object of this retrospective study was to analyze the relationship between the active contact location and seizure reduction to establish an atlas-based optimal target for ATN DBS.METHODSFrom among 25 patients who had undergone ATN DBS surgery for drug-resistant epilepsy between 2016 and 2018, those who had follow-up evaluations for more than 1 year were eligible for study inclusion. After an initial stimulation period of 6 months, patients were classified as responsive (≥ 50% median decrease in seizure frequency) or nonresponsive (< 50% median decrease in seizure frequency) to treatment. Stimulation parameters and/or active contact positions were adjusted in nonresponsive patients, and their responsiveness was monitored for at least 1 year. Postoperative CT scans were coregistered nonlinearly with preoperative MR images to determine the center coordinate and atlas-based anatomical localizations of all active contacts in the Montreal Neurological Institute (MNI) 152 space.RESULTSNineteen patients with drug-resistant epilepsy were followed up for at least a year following bilateral DBS electrode implantation targeting the ATN. Active contacts located more adjacent to the center of gravity of the anterior half of the ATN volume, defined as the anterior center (AC), were associated with greater seizure reduction than those not in this location. Intriguingly, the initially nonresponsive patients could end up with much improved seizure reduction by adjusting the active contacts closer to the AC at the final postoperative follow-up.CONCLUSIONSPatients with stimulation targeting the AC may have a favorable seizure reduction. Moreover, the authors were able to obtain additional good outcomes after electrode repositioning in the initially nonresponsive patients. Purposeful and strategic trajectory planning to target this optimal region may predict favorable outcomes of ATN DBS.

Anterior Nucleus of Thalamus Deep Brain Stimulation: A Clinical-Based Analysis of the Ideal Target in Drug-Resistant Epilepsy

2021 ◽  
pp. 1-13
Author(s):  
Ricardo Costa-Gertrudes ◽  
Diogo Simão ◽  
Ana Franco ◽  
Carlos Morgado ◽  
Ana Rita Peralta ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Anatomical Variations ◽  
Drug Resistant ◽  
Anterior Nucleus ◽  
Human Thalamus ◽  
Significant Difference ◽  
Drug Resistant Epilepsy ◽  
Deep Brain ◽  
The Ideal

<b><i>Introduction:</i></b> Deep brain stimulation of the anterior nucleus of thalamus (ANT-DBS) is an approved procedure for drug-resistant epilepsy. However, the preferred location inside ANT is not well known. In this study, we investigated the relationship between stereotactical coordinates of stimulated contacts and clinical improvement, in order to define the ideal target for ANT-DBS. <b><i>Methods:</i></b> Individual contact’s coordinates were obtained in the Montreal Neurological Institute (MNI) 152 space, with the utilization of advanced normalization tools and co-registration of pre- and postoperative MRI and CT images in open-source toolbox lead-DBS with the “Atlas of the Human Thalamus.” Each contact’s pair was either classified as a responder (≥50% seizure reduction and absence of intolerable adverse effects) or nonresponder, with a minimum follow-up of 11 continuous months of stimulation. <b><i>Results:</i></b> A total of 19 contacts’ pairs were tested in 14 patients. The responder rate was 9 out of 14 patients (64.3%). In 4 patients, a change in contacts’ pairs was needed to achieve this result. A highly encouraging location inside ANT (HELIA) was delimited in MNI space, corresponding to an area in the anterior and inferior portion of the anteroventral (AV) nucleus, medially to the endpoint of the mammillothalamic tract (ANT-mtt junction) (<i>x</i> [3.8; 5.85], <i>y</i> [−2.1; −6.35] and <i>z</i> [6.2; 10.1] in MNI space). Statistically significant difference was observed between responders and nonresponders, in terms of the number of coordinates inside this volume. Seven responders and two nonresponders had at least 5 of 6 coordinates (2 electrodes) inside HELIA (77.8% sensitivity and 80% specificity). In 3 patients, changing to contacts that were better placed inside HELIA changed the status from nonresponder to responder. <b><i>Conclusions:</i></b> A relationship between stimulated contacts’ coordinates and responder status was observed in drug-resistant epilepsy. The possibility to target different locations inside HELIA may help surpass anatomical variations and eventually obtain increased clinical benefit.

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