Deep brain stimulation of the centromedian thalamic nucleus for the treatment of generalized and frontal epilepsies

被引:214
作者
Valentin, Antonio [1 ,2 ]
Garcia Navarrete, Eduardo [3 ]
Chelvarajah, Ramesh [4 ,5 ]
Torres, Cristina [3 ]
Navas, Marta [3 ]
Vico, Lelia [1 ,6 ]
Torres, Nerea [7 ]
Pastor, Jesus [8 ]
Selway, Richard [5 ]
Sola, Rafael G. [3 ]
Alarcon, Gonzalo [1 ,2 ,9 ]
机构
[1] Kings Coll Hosp London, Dept Clin Neurophysiol, London, England
[2] Kings Coll London, Inst Psychiat, Dept Clin Neurosci, London SE5 8AS, England
[3] Univ Hosp La Princesa, Epilepsy Surg Unit, Madrid, Spain
[4] Queen Elizabeth Hosp, Dept Neurosurg, Birmingham B15 2TH, W Midlands, England
[5] Kings Coll Hosp London, Dept Neurosurg, London, England
[6] Royal Derby Hosp, Dept Clin Neurophysiol, Derby, England
[7] Doctor Peset Hosp, Dept Neurophysiol, Valencia, Spain
[8] Univ Hosp La Princesa, Dept Neurophysiol, Madrid, Spain
[9] Univ Complutense, Fac Med, Dept Physiol, E-28040 Madrid, Spain
关键词
Epilepsy; Seizure; Deep brain stimulation; Epilepsy surgery; Thalamus; Centromedian; PULSE ELECTRICAL-STIMULATION; RESPONSIVE CORTICAL STIMULATION; TEMPORAL-LOBE EPILEPSY; TERM-FOLLOW-UP; LONG-TERM; INTRACTABLE EPILEPSY; IN-VIVO; SEIZURES; SURGERY; ELECTRODE;
D O I
10.1111/epi.12352
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
PurposeDeep brain stimulation (DBS) of the thalamus is an emerging surgical option for people with medically refractory epilepsy that is not suitable for resective surgery, or in whom surgery has failed. Our main aim was to evaluate the efficacy of bilateral centromedian thalamic nucleus (CMN) DBS for seizure control in generalized epilepsy and frontal lobe epilepsy with a two-center, single-blind, controlled trial. MethodsParticipants were adults with refractory generalized or frontal lobe epilepsy. Seizure diaries were kept by patients/carers prospectively from enrollment. The baseline preimplantation period was followed by a control period consisting of a blind stimulation-OFF phase of at least 3months, a 3-month blind stimulation-ON phase, and a 6-month unblinded stimulation-ON phase. The control period was followed by an unblinded long-term extension phase with stimulation-ON in those patients in whom stimulation was thought to be effective. Key FindingsEleven patients were recruited at King's College Hospital (London, United Kingdom United Kingdom) and at University Hospital La Princesa (Madrid, Spain). Among the five patients with frontal lobe epilepsy, only one patient had >50% improvement in seizure frequency during the blind period. In the long-term extension phase, two patients with frontal lobe epilepsy had >50% improvement in seizure frequency. All six patients with generalized epilepsy had >50% improvement in seizure frequency during the blind period. In the long-term extension phase, five of the six patients showed >50% improvement in the frequency of major seizures (one became seizure free, one had >99% improvement, and three had 60-95% reduction in seizure frequency). Among patients with generalized epilepsy, the DBS implantation itself appears to be effective, as two patients remained seizure free during 12 and 50months with DBS OFF, and the remaining four had 50-91% improvement in the initial 3months with DBS OFF. SignificanceDBS implantation and stimulation of the CMN appears to be a safe and efficacious treatment, particularly in patients with refractory generalized epilepsy. CMN stimulation was not as effective in frontal lobe epilepsy, which requires further studies. DBS of the CMN should be considered as a treatment option, particularly in patients with refractory generalized epilepsy syndromes.
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页码:1823 / 1833
页数:11
相关论文
共 46 条
[21]   A prospective study of the requirement for and the provision of epilepsy surgery in the United Kingdom [J].
Lhatoo, SD ;
Solomon, JK ;
McEvoy, AW ;
Kitchen, ND ;
Shorvon, SD ;
Sander, JW .
EPILEPSIA, 2003, 44 (05) :673-676
[22]   Deep brain stimulation in epilepsy [J].
Loddenkemper, T ;
Pan, A ;
Neme, S ;
Baker, KB ;
Rezai, AR ;
Dinner, DS ;
Montgomery, EB ;
Lüders, HO .
JOURNAL OF CLINICAL NEUROPHYSIOLOGY, 2001, 18 (06) :514-532
[23]   Electrical stimulation of the hippocampal epileptic foci for seizure control: A double-blind, long-term follow-up study [J].
Luisa Velasco, Ana ;
Velasco, Francisco ;
Velasco, Marcos ;
Trejo, David ;
Castro, Guillermo ;
Damian Carrillo-Ruiz, Jose .
EPILEPSIA, 2007, 48 (10) :1895-1903
[24]   Neuromodulation of the centromedian thalamic nuclei in the treatment of generalized seizures and the improvement of the quality of life in patients with Lennox-Gastaut syndrome [J].
Luisa Velasco, Ana ;
Velasco, Francisco ;
Jimenez, Fiacro ;
Velasco, Marcos ;
Castro, Guillermo ;
Carrillo-Ruiz, Jose D. ;
Fanghanel, Guillermo ;
Boleaga, Bernardo .
EPILEPSIA, 2006, 47 (07) :1203-1212
[25]   Micro subthalamotomy:: An immediate predictor of long-term subthalamic stimulation efficacy in Parkinson disease [J].
Maltete, David ;
Derrey, Stephane ;
Chastan, Nathalie ;
Debono, Bertrand ;
Gerardin, Emmanuel ;
Freger, Pierre ;
Mihout, Bruno ;
Menard, Jean Francois ;
Hannequin, Didier .
MOVEMENT DISORDERS, 2008, 23 (07) :1047-1050
[26]   Brain penetration effects of microelectrodes and DBS leads in STN or GPi [J].
Mann, J. M. ;
Foote, K. D. ;
Garvan, C. W. ;
Fernandez, H. H. ;
Jacobson, C. E. ;
Rodriguez, R. L. ;
Haq, I. U. ;
Siddiqui, M. S. ;
Malaty, I. A. ;
Morishita, T. ;
Hass, C. J. ;
Okun, M. S. .
JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY, 2009, 80 (07) :794-797
[27]   Brain penetration effects of microelectrodes and deep brain stimulation leads in ventral intermediate nucleus stimulation for essential tremor [J].
Morishita, Takashi ;
Foote, Kelly D. ;
Wu, Samuel S. ;
Jacobson, Charles E. ;
Rodriguez, Ramon L. ;
Haq, Ihtsham U. ;
Siddiqui, Mustafa S. ;
Malaty, Irene A. ;
Hass, Christopher J. ;
Okun, Michael S. .
JOURNAL OF NEUROSURGERY, 2010, 112 (03) :491-496
[28]   Responsive cortical stimulation for the treatment of medically intractable partial epilepsy [J].
Morrell, Martha J. .
NEUROLOGY, 2011, 77 (13) :1295-1304
[29]   Sudden Unexpected Death in Epilepsy (SUDEP): Update and Reflections [J].
Nashef, Lina ;
Ryvlin, Philippe .
NEUROLOGIC CLINICS, 2009, 27 (04) :1063-+
[30]   Single-axon tracing and three-dimensional reconstruction of centre median-parafascicular thalamic neurons in primates [J].
Parent, M ;
Parent, A .
JOURNAL OF COMPARATIVE NEUROLOGY, 2005, 481 (01) :127-144