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Direct visual targeting versus preset coordinates for ANT-DBS in epilepsy.
Terje Nome1, Helle Herrman2,3,4, Kai Lehtimäki5
1Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway.
Acta Neurologica Scandinavica
|February 21, 2020
Summary
Deep brain stimulation (DBS) targeting for refractory focal epilepsy showed significant electrode misplacement. Accurate targeting of the anterior thalamic nucleus (ANT) is crucial for effective seizure reduction in DBS therapy.
Area of Science:
- Neurosurgery
- Epileptology
- Neuromodulation
Background:
- Refractory focal epilepsy presents a significant clinical challenge.
- Deep brain stimulation (DBS) of the anterior thalamic nucleus (ANT) is an investigational therapy.
- Previous trials, like the Oslo study, yielded suboptimal seizure reduction, prompting further investigation into targeting accuracy.
Purpose of the Study:
- To retrospectively analyze the electrode targeting and placement in the Oslo anterior thalamic nucleus deep brain stimulation study.
- To identify discrepancies between planned targets and actual electrode positions for anterior thalamic nucleus deep brain stimulation.
Main Methods:
- Utilized BrainLab MRI data from 12 patients in the Oslo study.
- Identified visually preferred target coordinates for the anterior thalamic nucleus (ANT).
- Compared planned implantation targets and actual electrode positions (from CT scans) with the visually identified ANT center.
Main Results:
- Significant deviations were observed between the visually identified target, planned target, and actual electrode positions.
- Average distances between the active electrode contact and the visually identified ANT center were 3.3 mm (right) and 2.9 mm (left).
Conclusions:
- Inaccurate targeting, potentially due to variations in ANT anatomy and reliance on indirect coordinate-based targeting, may explain the modest efficacy of ANT-DBS in the Oslo study.
- Improved MRI imaging for direct target identification is recommended for future anterior thalamic nucleus deep brain stimulation surgeries to enhance precision and outcomes.
