Corticothalamic Responsive Neurostimulation for Focal Onset Epilepsy: A Single Center Experience
Abstract number :
1.157
Submission category :
3. Neurophysiology / 3E. Brain Stimulation
Year :
2023
Submission ID :
241
Source :
www.aesnet.org
Presentation date :
12/2/2023 12:00:00 AM
Published date :
Authors :
Presenting Author: David Burdette, MD – Corewell Health
Sanjay Patra, MD, MSc – Corewell Health; Lise Johnson, PhD – NeuroPace, Inc.
Rationale: Due to its extensive, reciprocal connectivity with the cortex and other subcortical structures, the thalamus is considered an important target for neuromodulation in drug resistant focal epilepsy. Using corticothalamic stimulation it is possible to modulate both the thalamus and the cortical seizure onset zone. Limited published clinical experience describes corticothalamic stimulation with depth leads targeting one of the anterior (ANT), centromedian (CM), or pulvinar (PUV) thalamic nuclei. However, it is not clear which of these nuclei is the “best” therapeutic target.
Methods: This study comprises a single center’s experience with corticothalamic responsive neurostimulation using the RNS System to target these three thalamic nuclei. Presented here are methods for target selection and device programming, clinical outcomes, and a comparison of ictal and non-ictal electrophysiological features.
Results: In this small retrospective study, responsive corticothalamic neurostimulation was an effective therapy for 79% of patients (≥ 50% reduction in disabling seizure frequency), regardless of whether the thalamic lead was implanted in the ANT, PUV, or CM. Across patients, peaks in the interictal iEEG were observed at theta, beta, gamma, and sleep spindle frequencies. Changes in frequency content and distribution were observed over time in all three nuclei.
Conclusions: Corticothalamic responsive neurostimulation can potentially be an effective adjunctive therapy in drug resistant focal epilepsy. The intracranial data collected by the device can be used to personalize and optimize detection and stimulation therapy. These data can also contribute to a broader understanding of thalamic electrophysiology in the context of focal epilepsy.
Funding: No.
Neurophysiology