Deep brain stimulation for epilepsy: optimal targeting and clinical outcomes

Area of Science:

• Neurology
• Neurosurgery
• Epileptology

Background:

• Deep brain stimulation (DBS) is explored for drug-resistant epilepsy in non-surgical candidates.
• Numerous DBS targets exist, but a comprehensive synthesis is lacking due to distinct epilepsy network involvement.

Purpose of the Study:

• To systematically review and synthesize the literature on DBS for epilepsy.
• To analyze surgical targets, patient characteristics, outcomes, and electrode placements.
• To identify relationships between stimulation location and clinical outcomes.

Main Methods:

• Systematic review of 124 studies including case series, prospective, and retrospective research.
• Data collection on surgical targets, disease characteristics, outcomes, and electrode placements.
• Analysis of DBS electrode coordinates in a common template space and correlation with outcomes.

Main Results:

• 1210 patients and 20 distinct surgical targets were analyzed.
• Anterior (ANT) and centromedian (CM) thalamic nuclei are most studied, but other targets show promise.
• Significant relationships found: shorter distance to mammillothalamic tract junction for ANT-DBS (r=-0.55) and parvocellular CM stimulation for generalized epilepsy (CM-DBS).

Conclusions:

• Accurate targeting is paramount for effective DBS in epilepsy.
• A publicly available database and atlas of DBS targets are provided for further research.
• Findings emphasize the importance of precise electrode placement for optimizing seizure reduction.