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Targeting Neuronal Fiber Tracts for Deep Brain Stimulation Therapy Using Interactive, Patient-Specific Models

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Deep Brain Stimulation for Epilepsy: Biomarkers for Optimization.

Katrina L Dell¹, Mark J Cook^1,2, Matias I Maturana³

¹Department of Medicine, St. Vincent's Hospital, University of Melbourne, Level 4, 29 Regent Street, St Vincent's Hospital, Fitzroy, Victoria, 3065, Australia.

Current Treatment Options in Neurology

|September 28, 2019

Summary

Deep brain stimulation (DBS) shows variable efficacy for refractory epilepsy. Optimizing stimulation targets like the anterior nucleus of the thalamus (ANT) and hippocampus, alongside personalized parameter adjustments, can improve seizure control.

Keywords:

Anterior nucleus of the thalamus Circuit of Papez Deep brain stimulation Epilepsy Hippocampus Stimulation parameters

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Area of Science:

Neurology
Neurosurgery
Epileptology

Background:

Deep brain stimulation (DBS) offers Class I evidence for refractory epilepsy treatment.
Efficacy varies significantly among patients, suggesting a need for personalized approaches.
Suboptimal parameters or differing seizure types may contribute to treatment disparities.

Purpose of the Study:

To review recent clinical findings on DBS for epilepsy, focusing on anterior nucleus of the thalamus (ANT) and hippocampus targets.
To explore etiologies benefiting most from DBS and the role of neural responses in optimizing therapy.
To discuss the potential of closed-loop stimulation systems.

Main Methods:

Review of recent clinical results from large-scale controlled trials.
Analysis of DBS efficacy based on stimulation targets (ANT vs. hippocampus).
Evaluation of neural response biomarkers for stimulation optimization and closed-loop control.

Main Results:

Hippocampal stimulation may benefit both focal and generalized seizures.
Anterior nucleus of the thalamus (ANT) stimulation appears most effective for focal seizures.
Stimulation-evoked response shape changes serve as biomarkers for efficacy.
Novel biomarkers identified for potential closed-loop stimulation.

Conclusions:

Patient screening and stimulation parameter optimization are crucial for maximizing DBS efficacy in epilepsy.
Tailoring therapy to individual patient needs, potentially using recorded neural responses, is essential.
Closed-loop systems utilizing biomarkers hold promise for adaptive, effective DBS therapy.