Effects of pulvinar and combined pulvinar/anterior thalamic deep-brain stimulation on sleep: preliminary results

To explore the effect of PuM and combined PuM/ANT DBS on sleep in drug-resistant epilepsy (DRE).

We retrospectively collected data from DRE patients with PuM-DBS or combined PuM/ANT-DBS and at least one night of EEG recording. Visual scoring of the whole night and quantitative power spectrum analysis on the first and last NREM sleep cycles were performed. We compared sleep characteristics of intra- and inter-patients with PuM-DBS and combined PuM/ANT-DBS.

Five nights were analyzed across three patients. Patient 1 underwent three sequential nights with different DBS settings: ANT + /PuM + , ANT + /PuM-, and ANT + /PuM + . ANT-DBS, either alone or in combination, was associated with disrupted sleep architecture, particularly in the latter part of the night. Visual staging showed no clear differences over the nights. Quantitative analysis however showed a worst sleep architecture in the last NREM cycle, as disclosed by a lower normalized delta power, in the second night (ANT + /PuM-) compared with the first and third nights (ANT + /PuM +). In patients with PuM-DBS alone, in cyclic or continuous stimulation modalities, sleep structure appeared preserved, with normal sleep efficiency and a normalized delta power higher than that of patient one.

PuM-DBS, compared to ANT-DBS, appeared not to disrupt sleep architecture.