Abstracts

Rationale: The surgical treatment of cases with therapy refractory epilepsy, which are not candidates for resection, took place so far predominantly by means of Vagus nerve Stimulation. Based on the extensive experiences with the treatment of movement disorders, chronic high frequency deep brain stimulation may also be effective in patients with refractory epilepsy. Methods: The approach is based on the connections of the subthalamic nucleus (STN) to the superior colliculus (dorsal midbrain anticonvulsant zone). Individual reports of successful treatment for different types of epilepsy with DBS have already been presented. Five cases with progressive Myoclonus epilepsy are reported. The patient were operated in the context of a study. Deep Brain Stimulation electrodes (Medtronic 3387) were stereotactically implanted into the substantia nigra, pars reticulate (SNr) bilateraly under general anesthesia, followed by the implantation of a neurostimulation system (Kinetra™) after 4 days of external stimulation and EEG recording. No complications occurred. The coordinates for the active contacts in the STN/Snr range were related to the midcommisural point: x = ±11mm, y=-4mm, z=-6mm.Results: The medication of the patient remained unchanged before and after stimulation. Under deep brain stimulation myoclonic seizures could be reduced by 50 to 80% in intensity and frequency. The follow-up at present is 12 months. Since the effects are delayed, the adjustment and testing of the remaining contacts took place in the course of several months postoperatively.Conclusions: Systematic positive influence of DBS in progressive Myoclonic epilepsy in an adult patient is reported for the first time. In the context of the following study it will have to be clarified whether the STN or other targets are suitable for DBS and which long-term results can be obtained.