Centromedian region thalamic responsive neurostimulation mitigates idiopathic generalized and multifocal epilepsy with focal to bilateral tonic-clonic seizures

被引:10
作者
Nanda, Pranav [1 ,2 ]
Sisterson, Nathaniel [1 ,2 ]
Walton, Ashley [1 ,3 ]
Chu, Catherine J. [4 ]
Cash, Sydney S. [4 ]
Moura, Lidia M. V. R. [4 ]
Oster, Joel M. [5 ]
Urban, Alexandra [6 ]
Richardson, Robert Mark [1 ,2 ,3 ]
机构
[1] Massachusetts Gen Hosp, Dept Neurosurg, Boston, MA 02114 USA
[2] Harvard Med Sch, Dept Neurosurg, Boston, MA USA
[3] MIT, Dept Brain & Cognit Sci, Cambridge, MA USA
[4] Massachusetts Gen Hosp, Dept Neurol, Boston, MA USA
[5] Tufts Med Ctr, Dept Neurol, Boston, MA USA
[6] Univ Pittsburgh, Sch Med, Dept Neurol, Pittsburgh, PA USA
关键词
generalized epilepsy; neuromodulation; RNS therapy; surgery; thalamus; DEEP BRAIN-STIMULATION; ELECTRICAL-STIMULATION; PRESURGICAL EVALUATION; REFRACTORY EPILEPSY; NUCLEUS;
D O I
10.1111/epi.18070
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Objective: Although >30% of epilepsy patients have drug-resistant epilepsy (DRE), typically those with generalized or multifocal disease have not traditionally been considered surgical candidates. Responsive neurostimulation (RNS) of the centromedian (CM) region of the thalamus now appears to be a promising therapeutic option for this patient population. We present outcomes following CM RNS for 13 patients with idiopathic generalized epilepsy (IGE) and eight with multifocal onsets that rapidly generalize to bilateral tonic-clonic (focal to bilateral tonic-clonic [FBTC]) seizures. Methods: A retrospective review of all patients undergoing bilateral CM RNS by the senior author through July 2022 were reviewed. Electrodes were localized and volumes of tissue activation were modeled in Lead-DBS. Changes in patient seizure frequency were extracted from electronic medical records. Results: Twenty-one patients with DRE underwent bilateral CM RNS implantation. For 17 patients with at least 1 year of postimplantation follow-up, average seizure reduction from preoperative baseline was 82.6% (SD = 19.0%, median = 91.7%), with 18% of patients Engel class 1, 29% Engel class 2, 53% Engel class 3, and 0% Engel class 4. There was a trend for average seizure reduction to be greater for patients with nonlesional FBTC seizures than for other patients. For patients achieving at least Engel class 3 outcome, median time to worthwhile seizure reduction was 203.5 days (interquartile range = 110.5-343.75 days). Patients with IGE with myoclonic seizures had a significantly shorter time to worthwhile seizure reduction than other patients. The surgical targeting strategy evolved after the first four subjects to achieve greater anatomic accuracy. Significance: Patients with both primary and rapidly generalized epilepsy who underwent CM RNS experienced substantial seizure relief. Subsets of these patient populations may particularly benefit from CM RNS. The refinement of lead targeting, tuning of RNS system parameters, and patient selection are ongoing areas of investigation.
引用
收藏
页码:2626 / 2640
页数:15
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