Single-Center Experience of Neuromodulation Targeting the Centromedian Nucleus of the Thalamus for Treatment of Drug-Resistant Epilepsy
Abstract number :
2.312
Submission category :
9. Surgery / 9A. Adult
Year :
2023
Submission ID :
870
Source :
www.aesnet.org
Presentation date :
12/3/2023 12:00:00 AM
Published date :
Authors :
Presenting Author: Kapil Gururangan, MD – University of California, Los Angeles
Ausaf Bari, MD, PhD – Neurosurgery – University of California, Los Angeles; Itzhak Fried, MD, PhD – Neurosurgery – University of California, Los Angeles; Inna Keselman, MD, PhD – Neurology – University of California, Los Angeles; Dawn Eliashiv, MD – Neurology – University of California, Los Angeles
Rationale: Neuromodulation approaches, especially deep brain stimulation (DBS) and responsive neurostimulation (RNS), are increasingly utilized in the surgical treatment of drug-resistant epilepsy (DRE), especially for patients ineligible for resective/ablative approaches. Emerging thalamic stimulation paradigms targeting either the anterior (ANT) or centromedian (CMT) thalamic nuclei with either intracranial neurostimulator aim to extend neuromodulation treatments to the broader population of patients, especially those with generalized or developmental epilepsies. However, clinical outcomes with thalamic neuromodulation approaches warrant further investigation.
Methods: We retrospectively identified all adult patients who underwent either DBS or RNS implantation for treatment of DRE with at least one thalamic contact (ANT or CMT) and assessed seizure outcomes recorded at the time of the last follow-up visit relative to their pre-implant seizure frequency. We also recorded clinical characteristics of our cohort, including epilepsy diagnosis (focal epilepsy, multifocal epilepsy, idiopathic generalized epilepsy [IGE], or Lennox-Gastaut syndrome [LGS]), epilepsy duration, number of current and prior anti-seizure medications (ASMs), prior intracranial monitoring, and prior treatment with surgical resection or vagus nerve stimulation (VNS). Statistical significance of seizure outcomes was assessed using Wilcoxon signed-rank test.
Results: A total of twenty-two adult patients underwent thalamic neuromodulation with either DBS (n=15; 12 bilateral ANT, 3 bilateral CMT) or RNS (n=7; 0 ANT, 6 bilateral CMT, 1 unilateral CMT and ipsilateral cortical strip. Epilepsy diagnosis was focal in 11 (50.0%), multifocal in 4 (18.2%), IGE in 4 (18.2%), and LGS in 3 (13.6%). Median age at implant was 27.6 (IQR 21.9-37.1) years, and median epilepsy duration at implant was 16.7 (IQR 9.2-20.1) years. Patients were taking a median of 2.5 (IQR 2.0-3.0) ASMs at the time of implant and had already tried a median of 4.5 (IQR 3.0-8.5) ASMs. Ten patients (45.5%) had undergone intracranial monitoring; 13 (59.1%) were treated with VNS and 5 (22.7%) had undergone epilepsy surgery. Over a median follow-up duration of 0.7 (IQR 0.1-2.8) years, median monthly seizure frequency decreased from 8.0 (IQR 2.0-26.8) to 3.5 (IQR 1.0-15.0), although this did not reach statistical significance (p=0.15). At least 50% reduction in seizure frequency was observed in nine patients (40.9%). When considering only patients with at least one year of follow-up (n=10), median monthly seizure frequency decreased from 7.0 (IQR 2.0-15.8) to 2.0 (IQR 0.3-5.8) with at least 50% reduction in seizure frequency observed in seven patients (70.0%).
Conclusions: Thalamic neuromodulation represents an emerging paradigm that may be helpful for treating patients with DRE that might be otherwise ineligible for other surgical approaches. Prospective multicenter studies with longer follow-up will be important to validate these findings.
Funding: This study received no funding support. KG, IF, and IK have no relevant disclosures. AAB has received consulting fees from Medtronic. DSE has received clinical trial grant support and speaker bureau honoraria from NeuroPace.
Surgery