Centromedian thalamic deep brain stimulation for idiopathic generalized epilepsy: Connectivity and target optimization.

Autor: Park S; Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA., Permezel F; Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA., Agashe S; Department of Neurology, Duke University, Durham, North Carolina, USA., Osman G; Division of Child Neurology, Department of Pediatrics, McGovern Medical School at UTHealth, Houston, Texas, USA., Simpson HD; Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.; Department of Neurology, Alfred Health, Melbourne, Victoria, Australia., Miller KJ; Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA., Van Gompel JJ; Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA., Starnes K; Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA., Lundstrom BN; Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA., Worrell GA; Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA., Gregg NM; Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.
Jazyk: angličtina
Zdroj: Epilepsia [Epilepsia] 2024 Sep 14. Date of Electronic Publication: 2024 Sep 14.
DOI: 10.1111/epi.18122
Abstrakt: There are limited treatment options for individuals with drug-resistant idiopathic generalized epilepsy (IGE). Small, limited case series suggest that centromedian thalamus deep brain stimulation (CM-DBS) may be an effective treatment option. The optimal CM-DBS target for IGE is underexamined. Here, we present a retrospective analysis of CM-DBS targeting and efficacy for five patients with drug-resistant IGE. Volume of tissue activated (VTA) overlap with CM nucleus was performed using an open-source toolbox. Median follow-up time was 13 months. Median convulsive seizure frequency reduction was 66%. One patient had only absence seizures, with >99% reduction in absence seizure frequency. Four patients had electrode contacts positioned within the CM nucleus target, all of whom had >50% reduction in primary semiology seizure, with 85% median seizure reduction (p = .004, paired-sample t test). Volumetric "sweet-spot" mapping revealed that best outcomes were correlated with stimulation of the middle ventral CM nucleus. Connectivity strength between the sweet-spot region and central peri-Rolandic cortex was increased significantly relative to other cortical regions (p = 8.6 × 10 -4 , Mann-Whitney U test). Our findings indicate that CM-DBS can be an effective treatment for patients with IGE, highlight the importance of accurate targeting and targeting analysis, and within the context of prior work, suggest that ideal CM-DBS targets may be syndrome specific.
(© 2024 International League Against Epilepsy.)
Databáze: MEDLINE
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