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A Comprehensive Protocol for Manual Segmentation of the Medial Temporal Lobe Structures
Published on: July 2, 2014
The effect of medial pulvinar stimulation on temporal lobe seizures
Cristina Filipescu1, Stanislas Lagarde1,2, Isabelle Lambert1,2
1Clinical Neurophysiology and Epileptology Department, Timone Hospital, Assitance Publique Hôpitaux de Marseille, Marseille, France.
Abstract:
We investigated the effect of electrical stimulation of the medial pulvinar (PuM) in terms of its effect on temporal lobe seizures. Eight patients with drug-resistant temporal lobe epilepsy undergoing stereoelectroencephalographic exploration were included. All had at least one electrode exploring the PuM. High-frequency (50 Hz) stimulations of the PuM were well tolerated in the majority of them. During diagnostic stimulation to confirm the epileptogenic zone, 19 seizures were triggered by stimulating the hippocampus. During some of these seizures, ipsilateral pulvinar stimulation was applied (130 Hz, pulse width = 450 microseconds, duration = 3-7 seconds, 1-2 mA). Compared to non-PuM-stimulated seizures, five of eight patients experienced clinically less severe seizures, particularly in terms of degree of alteration of consciousness. On the electrical level, seizures were more rapidly clonic with a shorter tonic phase. This proof of concept study is the first to suggest that PuM stimulation could be a well-tolerated and effective means of therapeutic deep brain stimulation in drug-resistant epilepsies.
Insights
Electrical stimulation of the medial pulvinar (PuM) may reduce seizure severity in drug-resistant temporal lobe epilepsy. This deep brain stimulation approach was well-tolerated and showed promise for epilepsy treatment.
Area of Science:
- Neurology
- Neurosurgery
- Epileptology
Background:
- Temporal lobe epilepsy (TLE) is a common focal epilepsy, often drug-resistant.
- The medial pulvinar (PuM) is a nucleus within the thalamus with potential roles in seizure networks.
- Stereoelectroencephalography (SEEG) is an invasive method for epilepsy diagnosis and localization.
Purpose of the Study:
- To investigate the therapeutic potential of high-frequency electrical stimulation of the medial pulvinar (PuM) in patients with drug-resistant TLE.
- To assess the tolerability and clinical/electrical effects of PuM stimulation during SEEG exploration.
Main Methods:
- Eight patients with drug-resistant TLE undergoing SEEG exploration were included.
- Electrodes were placed to explore the PuM, and high-frequency stimulation (50 Hz) was applied.
- During seizures triggered by hippocampal stimulation, ipsilateral PuM stimulation (130 Hz) was delivered and compared to non-stimulated seizures.
Main Results:
- PuM stimulation was generally well-tolerated.
- Five of eight patients experienced clinically less severe seizures, notably with reduced alteration of consciousness.
- Electrically, PuM stimulation shortened the tonic phase and increased the clonic phase of seizures.
Conclusions:
- Medial pulvinar stimulation represents a potential novel therapeutic target for deep brain stimulation in drug-resistant epilepsy.
- This proof-of-concept study suggests PuM stimulation is a well-tolerated and effective strategy for managing TLE seizures.
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