Authors :
Presenting Author: Ganne Chaitanya, MD, PhD – The University of Texas Health Science Center at Houston
Vladimir Vashin, BS – UTHealth Houston
Jeston Chin, BS – UTHealth Houston
Mohammad Alisali, MD – University of Texas Health Science Center at Houston
John Mosher, PhD – University of Texas Health Science Center at Houston
Manojkumar Saranathan, PhD – UMass Chan Medical School
Dennis Lal, PhD – Department of Neurology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
Samden Lhatoo, MD – UTHealth Houston
Nitin Tandon, MD – McGovern Medical School, University of Texas Health Science Center at Houston
Jay Gavvala, MD – UTHealth Houston
Sandipan Pati, MD – University of Minnesota
Rationale:
Developmental and epileptic encephalopathies (DEEs) are severe early-onset neurological disorders characterized by refractory seizures and progressive neurodevelopmental decline, often resistant to conventional treatments. This study aims to monitor the outcomes of centromedian (CM) thalamic deep brain stimulation (DBS) as a therapeutic approach to reduce seizures for intractable DEEs.Methods:
12 patients with DEE underwent CM thalamic neuromodulation (2 RNS; 10 DBS-1 patient had CM + pulvinar-PUL). Electrode localization was confirmed by co-registering post-implant CT with pre-implant MRI, with thalamic nuclei identified using THOMAS segmentation. (1). Seizure reduction was assessed as a percentage change. Cyclicity analysis of interictal epileptiform activity (IEA) was performed using power in band (PIB) data from DBS, while fitting oscillations and one-over-F (FOOOF) analysis was employed to evaluate nucleus-specific effects on thalamic local field potentials (LFPs). Results:
Out of the 12 patients, 10 had accurate electrode localization to the CM nucleus, while 2 had electrodes in close proximity, with the volume of tissue activated (VTA) overlapping the CM. Two patients became seizure-free, four experienced a >50% reduction in seizures, three had a 25-50% reduction, and one showed no change. Cyclicity analysis revealed circadian peaks in IEA in DBS-patients with effective treatment, while the non-responder did not exhibit distinct cyclical patterns in IEA. In one patient with both CM and PUL DBS, LFP changes from CM stimulation were linked to clinical improvement, while PUL stimulation had no significant effect (Figure 1 and 2).
Conclusions:
CM neuromodulation demonstrates significant potential for managing refractory seizures in DEEs, with notable reductions in seizure frequency and modulation of epileptiform activity. These findings support the therapeutic efficacy of CM DBS, offering a promising intervention for patients with intractable DEEs where conventional treatments fail.Funding: Although my work on thalamic neuromodulation is supported by an NIH R25 grant, the current funding is insufficient to cover expenses for my presentation at the AES conference. (Number:
NS113757)