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Seizure Detection and Lateralization Using Thalamic Deep Brain Stimulator Recordings.

Gloria Ortiz-Guerrero1, Sihyeong Park1, Keith Starnes1

  • 1Department of Neurology, Mayo Clinic, Rochester, Minnesota, U.S.A. ; and.

Journal of Clinical Neurophysiology : Official Publication of the American Electroencephalographic Society
|December 18, 2024
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Summary

Deep brain stimulation (DBS) recordings show promise for detecting and localizing seizures in epilepsy. This case study highlights the feasibility of using thalamic DBS for seizure detection and lateralization in a patient with drug-resistant epilepsy.

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Area of Science:

  • Neuroscience
  • Epileptology
  • Biomedical Engineering

Background:

  • Reliable seizure detection is a critical unmet need in epilepsy management.
  • Deep brain stimulation (DBS) systems offer potential for ambulatory brain recordings, but their utility for seizure detection is underexplored.
  • Limited data exist on using DBS recordings for seizure detection and lateralization.

Purpose of the Study:

  • To investigate the feasibility of seizure detection and lateralization using thalamic deep brain stimulation (DBS) recordings.
  • To explore the potential of DBS sensing parameters guided by stereotactic-EEG findings.

Main Methods:

  • Case study of an 18-year-old patient with drug-resistant focal epilepsy.
  • Pre-surgical stereotactic-EEG with a thalamus lead to identify seizure onset zones.
  • Post-implantation of an anterior nucleus of the thalamus DBS system with low-frequency power-in-band (5.3-10.3 Hz) recordings.
  • Correlation of thalamic DBS trends with nurse-identified clinical seizures.

Main Results:

  • Stereotactic-EEG identified independent left orbitofrontal and mesial temporal seizure onsets with elevated low-frequency thalamic ictal power.
  • Thalamic DBS recordings showed relative power peaks coincident with four clinically identified seizures.
  • Peri-ictal power was consistently maximal ipsilateral to the seizure network, enabling lateralization.

Conclusions:

  • Thalamic DBS systems demonstrate feasibility for seizure detection and lateralization in select individuals with epilepsy.
  • DBS sensing parameter selection may be informed by pre-surgical stereotactic-EEG data.
  • Further research is required to establish the generalizability of DBS-based seizure detection across diverse patient populations and seizure networks.