Abstracts

RATIONALE:_High frequency stimulation of deep cerebral gray matter structures has recently been successfully applied to the treatment of neurologic disease. Stimulation of structures such as the centromedian nucleus of the thalamus and the subthalamic nucleus (STN) produces a demonstrable inhibitory influence in the treatment of Parkinson s disease and other tremors. Recent animal studies have demonstrated a suppressive effect of STN stimulation on seizures as well. We report the first North American use of bilateral STN stimulation for the treatment of medically intractable epilepsy. METHODS:_The patient is a 34-year-old right-handed male with a 22-year history of intractable seizures. He had an average of 10 automotor seizures per week while taking four antiepileptic agents. MRI evaluation revealed numerous bilateral and bitemporal cavernous malformations. Multiple phase I video/EEG evaluations demonstrated bitemporal ictal patterns, precluding surgical resection of an epileptic lesion. He was approved for an FDA investigational protocol studying the role of bilateral STN stimulation. The stimulators were implanted using frame-based stereotactic guidance and microelectrode recordings. RESULTS:_At post-operative follow-up of seven months, there has been a demonstrable reduction in seizure frequency, with the patient reporting 10 seizures in this time period. CONCLUSIONS:_These results may imply a role for deep brain stimulation in highly selected cases of medically intractable epilepsy.