Authors :
Presenting Author: Joel Sullivan, DO – The University of Alabama at Birmingham
Nicole Bentley, MD – The University of Alabama at Birmingham; Kristen Riley, MD – The University of Alabama at Birmingham; Lawrence Ver Hoef, MD – The University of Alabama at Birmingham; Jerzy Szaflarski, MD, Ph.D. – The University of Alabama at Birmingham; Zeenat Jaisani, MD – The University of Alabama at Birmingham
Rationale:
Deep brain stimulation (DBS) is an FDA approved treatment for drug-resistant epilepsy. The purpose of our research is to show seizure response rate and side effects following DBS implantation at a single level four comprehensive epilepsy center.
Methods:
We retrospectively reviewed nine patients who underwent DBS implantation at our center between 2019 and May 2023. We evaluated cumulative (focal impaired awareness and bilateral tonic-clonic) seizure frequency at post-implantation time points of Six and twelve months and compared them to pre-implantation seizure frequency. Additionally, we reported any post-implantation stimulation related side effects. Our data was collected by reviewing our electronic medical record (EMR).
Results:
This cohort included five males and four females with an average age of 31 (range 21-66). Seven patients had multifocal epilepsy, one with generalized epilepsy, and one patient had left lateralized epilepsy. All of the nine patients underwent implantation of bilateral anterior nuclei of the thalamus and the therapy was initiated anywhere from four days to six weeks thereafter. One patient was excluded from our data due to inadequate follow-up.
At six month follow-up, six patients had at least 50% improvement in seizure burden (50-92%), one had no change in seizure burden and one had increased seizure burden. These statistics carried over at the 12-month period. One patient in the responder group had further improvement to 100% reduction in seizure burden. One patient continued to have no change in frequency and one continued to have worsening seizure burden.
Side effects from DBS stimulation in our cohort include depression (4), visual hallucinations (1), intrusive thoughts (1, improved with stimulation adjustment), dizziness (2), and transient urinary urgency (2). One patient who reported worsening depression and visual hallucinations had improvement once their DBS settings were changed. Another patient reported worsening depression when coming off Risperdal. The patient described above with worsening seizure burden also had worsening depression and their DBS was turned off at their 12-month appointment.
Conclusions:
In our cohort, we see a more than 50% improvement in six out of eight (75%) patients at 12 months after therapy initiation. This is higher than the response rate as reported from the SANTE trial (43%) at 13 month but similar to the five year (68%) responder rate. However, ours is a small non-randomized cohort, limiting this comparison. We also found that the adverse events are tolerable in most patients with stimulation adjustments. Our study shows that at our level four comprehensive epilepsy center DBS of the Anterior Nucleus of the thalamus has been beneficial and should continue to be used in select patients with drug resistant epilepsy.
Funding: There was no funding received in support of this abstract.