OBJECTIVE: To report on the outcome after thalamic anterior nuclei (AN) and centromedian (CM) deep brain stimulation (DBS) in four medically refractory epilepsy patients, who were either not candidates for resection surgery or refractory to the treatment of vagus nerve stimulation and/or resection surgery. BACKGROUND: Experimental and clinical studies have suggested that electrical DBS of subcortical structures is a promising therapy for patients with refractory epilepsy. Bilateral stimulation of the AN of the thalamus is useful for some patients with medically refractory partial seizure, while the efficacy of bilateral CM nucleus stimulation in generalized forms of epilepsy has been recently identified. DESIGN/METHODS: We retrospectively reviewed the records of 4 patients from the Mayo Clinic DBS Program database with medically refractory epilepsy who underwent bilateral AN and CM DBS. Two patients were admitted to Epilepsy Monitor Unit for further DBS programming based on their EEG recording results. RESULTS: One male and three female patients with median age of 14 years (range 5-19 years) at surgery underwent DBS. Median duration of epileptic history was 11 years (range 4-18 years). All patients recuperated well from the surgical procedure and post-operative MRI documented that all electrodes were correctly located. Average postoperative follow-up was 16 months (range 13-18 months). The average seizure frequency reduction was 63 percent. One patient had been seizure free for 12 months. Additionally, one patient experienced wound dehiscence requiring revision of the generator; otherwise no complications occurred. CONCLUSIONS: These findings suggested that bilateral stimulation of the AN and CM of the thalamus could potentially reduce seizures in medically refractory epilepsy patients who were either refractory to vagus nerve stimulation, or not candidates for resective surgery. DBS programming based on EEG recording results in Epilepsy Monitor Unit is useful for seizure management. Study Supported by:
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Hu et al. (2014) studied this question.