Centromedian thalamic deep brain stimulation for idiopathic generalized epilepsy: Connectivity and target...

Area of Science:

• Neurology
• Neurosurgery
• Epileptology

Background:

• Idiopathic generalized epilepsy (IGE) presents limited therapeutic options for drug-resistant cases.
• Centromedian thalamus deep brain stimulation (CM-DBS) shows potential but requires optimized targeting strategies.

Purpose of the Study:

• To retrospectively analyze CM-DBS targeting and efficacy in five patients with drug-resistant IGE.
• To identify optimal CM-DBS targets within the centromedian nucleus for IGE treatment.

Main Methods:

• Retrospective analysis of five drug-resistant IGE patients treated with CM-DBS.
• Volume of Tissue Activated (VTA) analysis using an open-source toolbox to assess target overlap.
• Correlation of stimulation sweet-spots with seizure frequency reduction and cortical connectivity.

Main Results:

• Median 66% reduction in convulsive seizure frequency after 13 months follow-up.
• Patients with electrodes in the CM nucleus achieved an 85% median seizure reduction.
• Optimal outcomes correlated with stimulation of the middle ventral CM nucleus and increased connectivity to peri-Rolandic cortex.

Conclusions:

• CM-DBS is an effective treatment for drug-resistant IGE.
• Precise targeting of the middle ventral CM nucleus is vital for maximizing therapeutic benefits.
• Optimal CM-DBS targets may be epilepsy syndrome-specific.