Acute Disruption of Cortical Epileptiform Discharges With Thalamic Stimulation

Area of Science:

• Neurology
• Neurosurgery
• Epileptology

Background:

• Thalamic neuromodulation is a developing treatment for drug-resistant epilepsy.
• Anterior nucleus of the thalamus deep brain stimulation is FDA-approved; centromedian nucleus is an emerging target.
• Limited data exists on acute effects of thalamic stimulation on epileptiform activity.

Purpose of the Study:

• To investigate the acute effects of anterior nucleus of the thalamus and centromedian nucleus stimulation on cortical epileptiform activity.
• To provide evidence supporting thalamic nuclei as targets for epilepsy neuromodulation.
• To explore the utility of stereoelectroencephalography in guiding neuromodulation target selection.

Main Methods:

• Case mini-series utilizing stereoelectroencephalography (SEEG) to monitor brain activity.
• Stimulation of anterior nucleus of the thalamus and centromedian nucleus in patients with epilepsy.
• Analysis of acute changes in cortical epileptiform activity following thalamic stimulation.

Main Results:

• Anterior nucleus of the thalamus stimulation acutely suppressed epileptiform activity in the cingulate cortex.
• Centromedian nucleus stimulation acutely suppressed epileptiform activity in the insular cortex.
• Findings suggest thalamic nuclei can modulate cortical seizure activity.

Conclusions:

• Thalamic neuromodulation demonstrates potential for both acute and chronic epilepsy management.
• Stereoelectroencephalography implantation in thalamic nuclei offers clinical insights for target selection.
• This research supports the therapeutic role of thalamic nuclei in treating epilepsy.