Targeted multinodal thalamic deep brain stimulation for epilepsy: A retrospective case series

Area of Science:

• Neurology
• Neurosurgery
• Epilepsy Research

Background:

• Emerging evidence suggests multi-lead thalamic deep brain stimulation (DBS) may benefit patients with diffuse or poorly defined epileptic networks.
• However, further research is needed to support these off-label applications.

Purpose of the Study:

• To investigate the feasibility, safety, and clinical utility of off-label multinodal thalamic DBS in patients with medically refractory and poorly localized epilepsies.
• To assess changes in seizure frequency and complications associated with this treatment approach.

Main Methods:

• A single-center, retrospective, non-controlled observational pilot study.
• Implantation of four DBS leads into bilateral anterior nuclei (ANT) and centromedian (CM) or mediodorsal (MD) and pulvinar (PLV) thalamic nuclei.
• Personalized targeting based on EEG and stereoencephalography data, with primary outcomes including complications and seizure frequency changes.

Main Results:

• DBS implantation was well-tolerated with no intraoperative complications and only one postoperative wound-related complication.
• Nine out of ten patients experienced a clinically significant reduction in seizure frequency, with two patients becoming seizure-free.
• Efficacy was comparable between two-lead and four-lead stimulation configurations.

Conclusions:

• Targeted multinodal thalamic DBS appears feasible and safe for medically refractory, poorly localized epilepsy.
• Preliminary data suggest clinical utility, but findings should be interpreted cautiously due to the non-controlled nature of the study.
• Larger controlled studies are warranted to rigorously evaluate the efficacy of personalized multinodal thalamic DBS for diffuse epileptic networks.