Chronic anterior thalamus stimulation for intractable epilepsy.
OBJECTIVE
A significant number of patients with epilepsy remain poorly controlled despite antiepileptic medication (AED) treatment and are not eligible for resective surgery. Novel therapeutic methods are required to decrease seizure burden in this population. Several observations have indicated that the anterior thalamic region plays an important role in the maintenance and propagation of seizures. We investigated neuromodulation of the anterior thalamus by using deep-brain stimulation (DBS) in patients with intractable seizures.


METHODS
Five patients with medically refractory epilepsy underwent stereotactic placement of and received stimulation through bilateral DBS electrodes in the anterior thalamus.


RESULTS
Treatment showed a statistically significant decrease in seizure frequency, with a mean reduction of 54% (mean follow-up, 15 months). Two of the patients had a seizure reduction of > or =75%. No adverse effects were observed after DBS electrode insertion or stimulation. Unexpectedly, the observed benefits did not differ between stimulation-on and stimulation-off periods.


CONCLUSIONS
DBS of the anterior thalamus is a safe procedure and possibly effective in patients with medically resistant seizures.
Hodaie
Mojgan
M
Division of Neurosurgery, University of Toronto, ON, Canada.
Wennberg
Richard A
RA
Dostrovsky
Jonathan O
JO
Lozano
Andres M
AM
D000328:Adult; D001931:Brain Mapping; D004599:Electric Stimulation Therapy / Q000379:methods*; D004567:Electrodes, Implanted; D004827:Epilepsy / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013239:Stereotyped Behavior; D013788:Thalamus / Q000502:physiology*; D016896:Treatment Outcome