title: Centro-median stimulation yields additional seizure frequency and attention improvement in patients previously submitted to callosotomy.
abstract: BACKGROUND
  Deep brain stimulation (DBS) has been increasingly used in the treatment of refractory epilepsy over the last decade. We report on the outcome after thalamic centro-median (CM) DBS in patients with generalized epilepsy who had been previously treated with extended callosal section.
  
  
  METHODS
  Four consecutive patients with generalized epilepsy who were previously submitted to callosal section and had at least 1 year of follow-up after deep brain implantation were studied. Age ranged from 19 to 44 years. All patients were submitted to bilateral CM thalamic DBS. Post-operative CT scans documented the electrode position in all patients. All patients had pre- and post-stimulation prolonged interictal scalp EEG recordings, including spike counts. Attention level was evaluated by means of the SNAP-IV questionnaire. The pre-implantation anti-epileptic drug regimen was maintained post-operatively in all patients.
  
  
  RESULTS
  Post-operative CT documented that all electrodes were correctly located. There was no morbidity or mortality. Seizure frequency reduction ranging from 65 to 95% and increased attention level was seen in all patients. Interictal spiking frequency was reduced from 25 to 95%, but their morphology remained the same. There was re-synchronization of interictal discharges during slow-wave sleep in 2 patients.
  
  
  CONCLUSIONS
  All patients benefit from the procedure. The CM seems to play a role in modulating the epileptic discharges and attention in these patients. On the other hand, it is not the generator of the epileptic abnormality and appeared not to be involved in non-REM sleep-related interictal spiking modulation.
authors: Epilepsy Surgery Program, Hospital Brigadeiro, São Paulo, SP, Brazil. acukiert@uol.com.br
authors: Arthur
authors: A
authors: Cukiert
authors: Jose Augusto
authors: JA
authors: Burattini
authors: Cristine Mella
authors: CM
authors: Cukiert
authors: Meire
authors: M
authors: Argentoni-Baldochi
authors: Carla
authors: C
authors: Baise-Zung
authors: Cássio Roberto
authors: CR
authors: Forster
authors: Valeria Antakli
authors: VA
authors: Mello
mesh_terms: D000328:Adult; D001288:Attention / Q000502:physiology*; D046690:Deep Brain Stimulation / Q000379:methods*; D004569:Electroencephalography / Q000379:methods; D004827:Epilepsy / Q000503:physiopathology* / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009483:Neuropsychological Tests; D050812:Split-Brain Procedure / Q000379:methods*; D013788:Thalamus / Q000502:physiology*; D014057:Tomography, X-Ray Computed / Q000379:methods; D055815:Young Adult