Optimizing stimulation parameters for anterior thalamic nuclei deep brain stimulation in epilepsy: A randomized...

Area of Science:

• Neuroscience
• Neurology
• Neurosurgery

Background:

• Optimizing deep brain stimulation (DBS) for epilepsy is challenging due to delayed effects.
• Anterior thalamic nuclei (ANT) DBS parameters are often limited to those from the SANTE trial.
• Low-frequency stimulation (LFS) for ANT-DBS is under-explored.

Purpose of the Study:

• To prospectively compare continuous low-frequency stimulation (cLFS) with alternative parameters against standard intermittent high-frequency stimulation (iHFS) for ANT-DBS in focal drug-resistant epilepsy.
• To evaluate the efficacy and safety of cLFS versus iHFS.

Main Methods:

• A randomized, modified crossover, open-label trial.
• Compared cLFS (7 Hz, 200 μs, continuous) to iHFS (145 Hz, 90 μs, 1 min on/5 min off).
• Patients switched settings after 3 months unless seizure-free, with final evaluation after another 3 months.

Main Results:

• Sixteen patients with median baseline seizure frequency of 13.8/month were analyzed.
• ANT-DBS significantly reduced overall seizure frequency by 62%.
• cLFS demonstrated a higher median seizure frequency reduction (73%) compared to iHFS (33%), with no severe adverse effects.

Conclusions:

• Continuous low-frequency stimulation (cLFS) is a safe and effective alternative for ANT-DBS in epilepsy management.
• Stimulation with varied parameters, including cLFS, can be as effective or more effective than standard iHFS.
• Results support exploring diverse stimulation parameter sets for ANT-DBS optimization.