title: Outcome based definition of the anterior thalamic deep brain stimulation target in refractory epilepsy.
abstract: BACKGROUND
  Deep brain stimulation of the anterior nucleus of the thalamus (ANT) is an emerging therapy for refractory focal epilepsy. However, the most optimal target for stimulation has not been unambiguously described.
  
  
  OBJECTIVE
  In the present study, we investigated the correlation between the stimulation site and outcome in order to define the optimal target for deep brain stimulation in refractory epilepsy.
  
  
  METHODS
  The locations of 62 contacts used in 30 treatment attempts in 15 prospectively followed patients during a 5 year period were assessed. Treatment attempts were classified into responding and non-responding trials using seizure reduction and side effect profile as criteria. The locations of active contacts were calculated with respect to mid-commissural point and visible borders of ANT in 3T MRI (ANT-normalized coordinate system) aiming to minimize the confounding effect of individual variation in the location and size of the ANT.
  
  
  RESULTS
  Contacts in successful treatment trials were located significantly more anterior and superior both in AC-PC and ANT-normalized coordinate systems. Favourable outcome was observed at 3T MRI based location of ANT but not at location predicted by Schaltenbrandt atlas sagittal data. Contacts used in successful trials were at anterior aspect of the ANT complex evidenced by the ANT-normalized coordinate system.
  
  
  CONCLUSIONS
  The anti-epileptic effect of anterior thalamic DBS may be dependent on stimulation site especially in the anterior to posterior axis. Extensive anatomical variation confounds severely the targeting of ANT. Therefore, direct visualization of the desired target for stimulation is essential for favourable outcome in refractory epilepsy.
authors.affiliation: Department of Neurosciences and Rehabilitation, Tampere University Hospital, Finland. Electronic address: kai.lehtimaki@pshp.fi.
authors.forename: K
authors.initials: K
authors.lastname: Lehtimäki
authors.affiliation: Department of Neurosciences and Rehabilitation, Tampere University Hospital, Finland.
authors.forename: T
authors.initials: T
authors.lastname: Möttönen
authors.affiliation: Department of Psychiatry, Tampere University Hospital, Finland.
authors.forename: K
authors.initials: K
authors.lastname: Järventausta
authors.affiliation: Department of Neurosurgery, Oulu University Hospital, Finland.
authors.forename: J
authors.initials: J
authors.lastname: Katisko
authors.affiliation: Department of Neurosciences and Rehabilitation, Tampere University Hospital, Finland.
authors.forename: T
authors.initials: T
authors.lastname: Tähtinen
authors.affiliation: Department of Neurosciences and Rehabilitation, Tampere University Hospital, Finland.
authors.forename: J
authors.initials: J
authors.lastname: Haapasalo
authors.affiliation: Department of Neurosciences and Rehabilitation, Tampere University Hospital, Finland.
authors.forename: T
authors.initials: T
authors.lastname: Niskakangas
authors.affiliation: Imaging Centre, Tampere University Hospital, Finland.
authors.forename: T
authors.initials: T
authors.lastname: Kiekara
authors.affiliation: Department of Neurosciences and Rehabilitation, Tampere University Hospital, Finland.
authors.forename: J
authors.initials: J
authors.lastname: Öhman
authors.affiliation: Department of Neurosciences and Rehabilitation, Tampere University Hospital, Finland.
authors.forename: J
authors.initials: J
authors.lastname: Peltola
mesh_terms: D000328:Adult; D020643:Anterior Thalamic Nuclei / Q000503:physiopathology*; D015986:Confounding Factors, Epidemiologic; D046690:Deep Brain Stimulation / Q000009:adverse effects / Q000379:methods*; D000069279:Drug Resistant Epilepsy / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012640:Seizures / Q000150:complications / Q000503:physiopathology / Q000628:therapy; D016896:Treatment Outcome; D055815:Young Adult
keywords: Anterior nucleus of the thalamus; Deep brain stimulation; Refractory epilepsy; Seizure; Targeting