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Multitarget deep brain stimulation for epilepsy.

Andrew I Yang1, Faical Isbaine1, Abdulrahman Alwaki2

  • 1Departments of1Neurosurgery and.

Journal of Neurosurgery
|July 24, 2023
PubMed
Summary
This summary is machine-generated.

Multi-target deep brain stimulation (DBS) offers a safe and feasible approach for drug-resistant epilepsy patients unsuitable for standard treatments. This method shows promise in reducing seizure frequency, particularly in complex epilepsy cases.

Keywords:
anterior nucleus of the thalamuscentromedian nucleusdeep brain stimulationepilepsymediodorsal nucleuspulvinar nucleussubthalamic nucleus

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Area of Science:

  • Neurosurgery
  • Epileptology
  • Neuromodulation

Background:

  • Deep brain stimulation (DBS) is an evolving surgical treatment for refractory epilepsy.
  • Standard DBS targets include the anterior nucleus of the thalamus (ANT) for frontal/temporal epilepsy and the centromedian (CM) nucleus for generalized epilepsy.
  • Patients with complex epilepsy syndromes often fall outside the criteria for these standard targets.

Purpose of the Study:

  • To evaluate the feasibility, safety, and seizure outcomes of multi-target DBS in patients with complex drug-resistant epilepsy.
  • To present the authors' experience with DBS targeting multiple distinct nuclei beyond ANT and CM.
  • To provide a basis for future research into the long-term efficacy of multitarget DBS.

Main Methods:

  • A single-center retrospective study involving adult patients with drug-resistant epilepsy.
  • Patients underwent DBS targeting 2-3 distinct thalamic/subthalamic nuclei, with two electrodes implanted per hemisphere.
  • Inclusion criteria encompassed epilepsy with multifocal, multilobar, diffuse-onset, posterior-onset, or combined generalized and focal seizures.

Main Results:

  • Eight patients received multi-target DBS without surgical complications.
  • Five patients with over six months of follow-up demonstrated a ≥50% reduction in overall and/or convulsive seizure frequency.
  • Two patients experienced transient adverse stimulation effects that were managed through programming adjustments.

Conclusions:

  • Multi-target DBS is a procedurally feasible and safe strategy for managing complex epilepsy.
  • This approach can potentially maximize treatment outcomes in patients with challenging epilepsy presentations.
  • Further adequately powered studies are needed to confirm the long-term efficacy of multitarget DBS.