A multicenter retrospective study of patients treated in the thalamus with responsive neurostimulation

Frontiers in Neurology

Neurology

Madeline C. Fields¹  Kyusang Lee¹  Anuradha Singh¹  Lara V. Marcuse¹  Jiyeoun Yoo¹  Onome Eka¹  Patricia Dugan²  Christopher Anderson³  Katie Bullinger⁴  Imran H. Quraishi⁵  Andrew S. Blum⁶  David E. Burdette⁷  Saadi Ghatan⁸  Fedor Panov⁸  Jon T. Willie⁹  Jason Gerrard^1,10  Wael F. Asaad^1,11  Cristina Schreckinger^1,12 

[1] Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States;Department of Neurology, Langone Medical Center, New York University, New York, NY, United States;Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, United States;Department of Neurology, School of Medicine, Emory University, Atlanta, GA, United States;Department of Neurology, School of Medicine, Yale University, New Haven, CT, United States;Department of Neurology, Warren Alpert Medical School, Brown University, Providence, RI, United States;Department of Neurosciences, Corewell Health, Grand Rapids, MI, United States;Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States;Department of Neurosurgery, School of Medicine, Washington University in St Louis, St. Louis, MO, United States;Department of Neurosurgery, School of Medicine, Yale University, New Haven, CT, United States;Department of Neurosurgery, Warren Alpert Medical School, Brown University, Providence, RI, United States;St. Mary’s Health Care System, Athens, GA, United States;

关键词: centromedian nucleus of thalamus;    anterior thalamic nucleus;    neuromodulation;    responsive neurostimulation (RNS);    drug-resistant epilepsy (DRE);    epilepsy surgery;   

DOI  :  10.3389/fneur.2023.1202631

 received in 2023-04-09, accepted in 2023-06-19,  发布年份 2023

来源: Frontiers

【 摘 要 】

IntroductionFor drug resistant epilepsy patients who are either not candidates for resective surgery or have already failed resective surgery, neuromodulation is a promising option. Neuromodulatory approaches include responsive neurostimulation (RNS), deep brain stimulation (DBS), and vagal nerve stimulation (VNS). Thalamocortical circuits are involved in both generalized and focal onset seizures. This paper explores the use of RNS in the centromedian nucleus of the thalamus (CMN) and in the anterior thalamic nucleus (ANT) of patients with drug resistant epilepsy.MethodsThis is a retrospective multicenter study from seven different epilepsy centers in the United States. Patients that had unilateral or bilateral thalamic RNS leads implanted in the CMN or ANT for at least 6 months were included. Primary objectives were to describe the implant location and determine changes in the frequency of disabling seizures at 6 months, 1 year, 2 years, and > 2 years. Secondary objectives included documenting seizure free periods, anti-seizure medication regimen changes, stimulation side effects, and serious adverse events. In addition, the global clinical impression scale was completed.ResultsTwelve patients had at least one lead placed in the CMN, and 13 had at least one lead placed in the ANT. The median baseline seizure frequency was 15 per month. Overall, the median seizure reduction was 33% at 6 months, 55% at 1 year, 65% at 2 years, and 74% at >2 years. Seizure free intervals of at least 3 months occurred in nine patients. Most patients (60%, 15/25) did not have a change in anti-seizure medications post RNS placement. Two serious adverse events were recorded, one related to RNS implantation. Lastly, overall functioning seemed to improve with 88% showing improvement on the global clinical impression scale.DiscussionMeaningful seizure reduction was observed in patients who suffer from drug resistant epilepsy with unilateral or bilateral RNS in either the ANT or CMN of the thalamus. Most patients remained on their pre-operative anti-seizure medication regimen. The device was well tolerated with few side effects. There were rare serious adverse events. Most patients showed an improvement in global clinical impression scores.

【 授权许可】

Unknown   
Copyright © 2023 Fields, Eka, Schreckinger, Dugan, Asaad, Blum, Bullinger, Willie, Burdette, Anderson, Quraishi, Gerrard, Singh, Lee, Yoo, Ghatan, Panov and Marcuse.