Authors :
Presenting Author: Michelle Calmet, MD – University of Pittsburgh Medical Center
Erafat Rehim, MD – University of Pittsburgh Medical Center
Golbarg Saber, MD – University of Pittsburgh Medical Center
Jorge González-Martínez, MD,PhD – University of Pittsburgh Medical School
Thandar Aung, MD,MS – University of Pittsburgh Medical School
Alexandra Urban, MD – University of Pittsburgh Medical Center
Rationale: Neuromodulation has significantly advanced the management of medically refractory epilepsy, with deep brain stimulation (DBS) and responsive neurostimulation (RNS) emerging as key therapeutic options. The SANTÉ trial demonstrated the efficacy of anterior nucleus of thalamus (ANT) DBS in reducing seizure frequency; however, continuous stimulation has been associated with adverse effects on memory and mood. Thalamic RNS, a closed-loop system that delivers stimulation in response to detected epileptiform activity, may reduce these risks while maintaining therapeutic efficacy. This study evaluates the neuropsychiatric and cognitive outcomes of thalamic RNS using PROMIS-16 scores.
Methods: We conducted a retrospective analysis of patients who underwent thalamic RNS implantation at a single center between 2019 and 2024. Patient-reported outcomes were assessed using the PROMIS-16 questionnaire, which evaluates mental, physical, and social health. Questionnaires were completed during routine outpatient visits 1–2 years post-implantation. Pathologic scores were defined as follows: Anxiety >62, Depression >60, Sleep Disturbance >65, and Cognitive Impairment >65. Patient demographics, epilepsy classification, lead localization, and Engel seizure outcomes at 12 months were recorded.
Results: Twenty-one patients were included (mean age: 34 years [range: 20–47]; 57% female). The median duration of epilepsy was 16 years. Eleven patients had generalized epilepsy, eight had focal epilepsy, and three had mixed types. All patients had bilateral thalamic leads; 71% in the centromedian nucleus, 33% in the pulvinar nucleus, and 0.5% in the anterior nucleus of the thalamus. Two patients also had cortical or subcortical leads. PROMIS-16 data were available for 17 patients at follow-up. Sleep Disturbance: 9 (53%) had normal scores, 7 (41%) had mild disturbance, and 1 (6%) had moderate disturbance. Depression: 10 (59%) had normal scores, 3 (18%) mild depression, and 3 (18%) moderate depression. Anxiety: 5 (29%) had normal scores, 4 (24%) mild anxiety, and 6 (35%) moderate anxiety. Cognition: 6 (35%) had normal cognition, 3 (18%) mild impairment, 3 (18%) moderate impairment, and 5 (29%) severe impairment. Seizure outcomes at 12 months were as follows: Engel Class I: 3, Engel Class II: 2 Engel Class III: 7, and Engel Class IV: 5.
Conclusions:
In this single-center cohort, thalamic RNS was associated with generally favorable mood and sleep outcomes, with most patients reporting normal to mild disturbances. Cognitive effects were more heterogeneous, with nearly half experiencing moderate to severe impairment. These preliminary findings suggest that closed-loop thalamic stimulation may offer neuropsychiatric benefits compared to continuous stimulation approaches, though further research in larger cohorts is needed to confirm long-term cognitive safety and efficacy.
Funding: .