title: Electrical stimulation of the anterior nucleus of the thalamus for the treatment of intractable epilepsy.
abstract: OBJECTIVE
  Animal studies and sporadic case reports in human subjects have suggested that intermittent electrical stimulation of the anterior nucleus of the thalamus reduces seizure activity. We embarked on an open-label pilot study to determine initial safety and tolerability of bilateral stimulation of the anterior nucleus of the thalamus (ANT), to determine a range of appropriate stimulation parameters, and to begin to gather pilot efficacy data.
  
  
  METHODS
  We report an open-label pilot study of intermittent electrical stimulation of the anterior nucleus of the thalamus in five patients (three men, two women; age range, 24-47 years), with follow-up between 6 and 36 months. All patients had intractable partial epilepsy. Four of the five patients also had secondarily generalized seizures. Stimulation was delivered by bilateral implantable, programmable devices by using an intermittent, relatively high-frequency protocol. Stimulation parameters were 100 cycles per second with charge-balanced alternating current; pulse width, 90 ms; and voltages ranging between 1.0 and 10.0 V. Seizure counts were monitored and compared with preimplantation baseline.
  
  
  RESULTS
  Four of the five patients showed clinically and statistically significant improvement with respect to the severity of their seizures, specifically with respect to the frequency of secondarily generalized tonic-clonic seizures and complex partial seizures associated with falls. One patient showed a statistically significant reduction in total seizure frequency. No adverse events could clearly be attributed to stimulation. None of the patients could determine whether the stimulator was on or off at these parameters.
  
  
  CONCLUSIONS
  Electrical stimulation of the ANT appears to be well tolerated. Preliminary evidence suggests clinical improvement in seizure control in this small group of intractable patients. Further controlled study of deep brain stimulation of the anterior nucleus is warranted.
authors.affiliation: Department of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA. jkerrigan@chw.edu
authors.forename: John F
authors.initials: JF
authors.lastname: Kerrigan
authors.forename: Brian
authors.initials: B
authors.lastname: Litt
authors.forename: Robert S
authors.initials: RS
authors.lastname: Fisher
authors.forename: Stephen
authors.initials: S
authors.lastname: Cranstoun
authors.forename: Jacqueline A
authors.initials: JA
authors.lastname: French
authors.forename: David E
authors.initials: DE
authors.lastname: Blum
authors.forename: Marc
authors.initials: M
authors.lastname: Dichter
authors.forename: Andrew
authors.initials: A
authors.lastname: Shetter
authors.forename: Gordon
authors.initials: G
authors.lastname: Baltuch
authors.forename: Jurg
authors.initials: J
authors.lastname: Jaggi
authors.forename: Selma
authors.initials: S
authors.lastname: Krone
authors.forename: MaryAnn
authors.initials: M
authors.lastname: Brodie
authors.forename: Mark
authors.initials: M
authors.lastname: Rise
authors.forename: Nina
authors.initials: N
authors.lastname: Graves
mesh_terms: D000328:Adult; D020643:Anterior Thalamic Nuclei / Q000502:physiology*; D004599:Electric Stimulation Therapy / Q000379:methods*; D004567:Electrodes, Implanted; D004827:Epilepsy / Q000503:physiopathology* / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects