Calvin Hu1, Chetan Nayak2, Surya Suresh3, Sandipan Pati3
1UT Houston, 2Washington University School of Medicine, 3University of Texas Health Science Center at Houston, Mc Govern Medical School
Objective:
The goal of this study is to help illuminate further investigation about the efficacy of multi-target thalamic DBS for epilepsy.
Background:
Deep brain stimulation is becoming a popular surgical option for patients with medically refractory seizures, especially those who are not candidates for resective surgery. Recent randomized controlled trials have shown the efficacy of stimulating the anterior nucleus of the thalamus (ANT) in anterior temporal and frontal lobe epilepsy. Centromedian nucleus has also been studied and found suited for generalized epileptic syndromes. This case series included patients who did not fit well within the criteria represented in the ANT and CM trials. Multiple DBS targets including ANT, CM, and Pulvinar nucleus of the thalamus were implemented during this study.
Design/Methods:
This is a single-center retrospective study of adult patients with medically refractory epilepsy who underwent multi-thalamic nuclei DBS placement. Retrospective chart review was done between the months of November 2022 to July 2023. Patients were identified for having treatment-resistant epilepsy with ANT or CM stimulation alone. These included multifocal, diffuse onset and posterior onset.
Results:
Four patients with medically refractory epilepsy underwent neuromodulation with DBS targeting at least 2 distinct thalamic nuclei. These included (i) one patient with bi-hemispheric perisylvian/limbic epilepsy; (ii) one patient with Dravet syndrome and multifocal epilepsy; (iii) one patient with bilateral temporal parietal epilepsy & (iv) one patient with left fronto-opercular-insular epilepsy. These patients were followed up for 6-8 months after DBS implantation. No surgical complications were reported during this time. Seizure reduction was reported was between 50-70% for these patients.
Conclusions:
This pioneering case series shows that multithalamic DBS placement may be a viable treatment option with complex multifocal epilepsy who are not candidates for resective epilepsy surgery. Further investigation will be necessary to assess the efficacy of this option.