title: Deep brain stimulation of anterior nucleus thalami disrupts sleep in epilepsy patients.
abstract: In view of the regulatory function of the thalamus in the sleep-wake cycle, the impact of deep brain stimulation (DBS) of the anterior nucleus thalami (ANT) on sleep was assessed in a small consecutive cohort of epilepsy patients with standardized polysomnography (PSG). In nine patients treated with ANT-DBS (voltage 5 V, frequency 145 Hz, cyclic mode), the number of arousals during stimulation and nonstimulation periods, neuropsychiatric symptoms (npS), and seizure frequency were determined. Electroclinical arousals were triggered in 14.0 to 67.0% (mean 42.4 ± SD 16.8%) of all deep brain stimuli. Six patients reported npS. Nocturnal DBS voltages were reduced in eight patients (one patient without npS refused) and PSGs were repeated. Electroclinical arousals occurred between 1.4 and 6.7 (mean 3.3 ± 1.7) times more frequently during stimulation periods compared to nonstimulation periods; the number of arousals positively correlated with the level of DBS voltage (range 1 V to 5 V) (Spearman's rank coefficient 0.53121; p < 0.05). No patient experienced seizure deterioration and four patients reported remission of npS. This case-cohort study provides evidence that ANT-DBS interrupts sleep in a voltage-dependent manner, thus putatively resulting in an increase of npS. Reduction of nocturnal DBS voltage seems to lead to improvement of npS without hampering efficacy of ANT-DBS.
authors.affiliation: Department of Epileptology, Protestant Hospital Alsterdorf, Hamburg, Germany.
authors.forename: Berthold R
authors.initials: BR
authors.lastname: Voges
authors.affiliation: Department of Neurology, University of Magdeburg, Magdeburg, Germany.
authors.forename: Friedhelm C
authors.initials: FC
authors.lastname: Schmitt
authors.affiliation: Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Hamel
authors.affiliation: Department of Epileptology, Protestant Hospital Alsterdorf, Hamburg, Germany.
authors.forename: Patrick M
authors.initials: PM
authors.lastname: House
authors.affiliation: Department of Neurology, University of Magdeburg, Magdeburg, Germany.|Center for Behavioural Brain Sciences (CBBS), Otto-von-Guericke- University, Magdeburg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Kluge
authors.affiliation: Department of Neurophysiology and Pathophysiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Christian K E
authors.initials: CK
authors.lastname: Moll
authors.affiliation: Department of Epileptology, Protestant Hospital Alsterdorf, Hamburg, Germany.
authors.forename: Stefan R
authors.initials: SR
authors.lastname: Stodieck
mesh_terms: D000328:Adult; D020643:Anterior Thalamic Nuclei; D015331:Cohort Studies; D046690:Deep Brain Stimulation / Q000009:adverse effects*; D004827:Epilepsy / Q000628:therapy; D017034:Epilepsy, Frontal Lobe / Q000628:therapy*; D004833:Epilepsy, Temporal Lobe / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D012890:Sleep; D007319:Sleep Initiation and Maintenance Disorders / Q000209:etiology*
keywords: Depression; Epilepsy monitoring unit; Insomnia; Memory; Polysomnography