Nucleus accumbens stimulation in partial epilepsy--a randomized controlled case series.
Neuromodulative treatment options are warranted in patients with difficult-to-treat epilepsy. However, acquisition of controlled data on deep brain stimulation has so far been achieved only for the centromedian and anterior thalamic nucleus. In a case series of four patients with intractable partial epilepsy, a randomized controlled cross-over protocol was used to get insight into efficacy and safety of 3-month nucleus accumbens stimulation. Seizure frequency, neurocognitive testing, "Liverpool Seizure Severity Score," "Quality of Life in Epilepsy Inventory," "Beck Depression Inventory," and "Mini International Neuropsychiatric Interview" were obtained at every visit. In a subsequent open-label phase, nucleus accumbens stimulation responders underwent concomitant anterior thalamic nucleus stimulation, whereas nonresponders received solely thalamic stimulation. Under nucleus accumbens stimulation, three of four patients had ≥ 50% reduction in frequency of disabling seizures without further improvement with additional anterior thalamic nucleus stimulation. Patient-reported outcome and neurocognitive testing remained unchanged. Accumbens stimulation is safe and seems to be a suitable option in intractable partial epilepsy. The current findings require substantiation by an adequately powered multicenter study.
Department of Neurology, Epilepsy-Center Berlin-Brandenburg, Charité - Universitätsmedizin Berlin, Germany.
Alexander B
AB
Kowski
Department of Stereotactic Neurosurgery, University of Magdeburg, Germany.|Leibniz Institute for Neurobiology (LIN), Magdeburg, Germany.
Jürgen
J
Voges
Leibniz Institute for Neurobiology (LIN), Magdeburg, Germany.|Department of Neurology, University of Magdeburg, Germany.
Hans-Jochen
HJ
Heinze
Epilepsy-Center Berlin-Brandenburg, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany.
Frank
F
Oltmanns
Department of Neurology, Epilepsy-Center Berlin-Brandenburg, Charité - Universitätsmedizin Berlin, Germany.|Epilepsy-Center Berlin-Brandenburg, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany.
Martin
M
Holtkamp
Department of Neurology, University of Magdeburg, Germany.
Friedhelm C
FC
Schmitt
D000328:Adult; D020643:Anterior Thalamic Nuclei / Q000502:physiology; D003071:Cognition / Q000502:physiology; D018592:Cross-Over Studies; D046690:Deep Brain Stimulation; D004828:Epilepsies, Partial / Q000523:psychology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D009714:Nucleus Accumbens / Q000502:physiology*; D011788:Quality of Life / Q000523:psychology; D016896:Treatment Outcome; D055815:Young Adult
Anterior thalamic nucleus; Deep brain stimulation; Epilepsy; Nucleus accumbens; Seizures