title: Chronic high-frequency deep brain stimulation of the STN/SNr for progressive myoclonic epilepsy.
abstract: Chronic high-frequency deep brain stimulation (DBS) may also be effective in patients with refractory epilepsy. A possible benefit has been postulated because of the connections that exist between the subthalamic nucleus (STN) and the superior colliculus. Individual case reports and pilot studies of successful DBS in different types of epilepsy have already been presented. Here, the case of a 39-year-old male with progressive myoclonic epilepsy is reported who remained severely impaired despite VNS and combined antiepileptic drug therapy. Bilateral DBS electrodes were implanted into the STN, followed by implantation of a neurostimulation system under general anesthesia. Adjustment and testing of the remaining contacts was done over several months postoperatively. Bilateral monopolar DBS reduced the intensity and frequency of seizures by 50%. The patient has so far been followed for 12 months. This is the first report of positive effects of DBS in progressive myoclonic epilepsy in an adult patient. A subsequent prospective study will have to investigate whether the STN or other target nuclei are most suitable for DBS in these types of epilepsy and which long-term results can be obtained.
authors.affiliation: Department of Stereotactic Neurosurgery, Neurocenter, Freiburg University Hospital, Freiburg, Germany. jan.vesper@uniklinik-freiburg.de
authors.forename: Jan
authors.initials: J
authors.lastname: Vesper
authors.forename: Bernhard
authors.initials: B
authors.lastname: Steinhoff
authors.forename: Sabine
authors.initials: S
authors.lastname: Rona
authors.forename: Christian
authors.initials: C
authors.lastname: Wille
authors.forename: Sonja
authors.initials: S
authors.lastname: Bilic
authors.forename: Guido
authors.initials: G
authors.lastname: Nikkhah
authors.forename: Christoph
authors.initials: C
authors.lastname: Ostertag
mesh_terms: D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use; D046690:Deep Brain Stimulation / Q000379:methods*; D004599:Electric Stimulation Therapy / Q000295:instrumentation; D004567:Electrodes, Implanted; D005500:Follow-Up Studies; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D020191:Myoclonic Epilepsies, Progressive / Q000628:therapy*; D013238:Stereotaxic Techniques; D020531:Subthalamic Nucleus / Q000502:physiology*; D013477:Superior Colliculi / Q000502:physiology*; D016896:Treatment Outcome; D014630:Vagus Nerve / Q000502:physiology
chemical_list: D000927:Anticonvulsants