Defining the optimal target for anterior thalamic deep brain stimulation in patients with drug-refractory epilepsy
| Autor: | Jung-Il Lee, Wendy Guo, Seung Bong Hong, Young-Min Shon, Rafeeque A. Bhadelia, Kyung Rae Cho, Eun Yeon Joo, Jae-Hun Kim, Seunghoon Lee, Dae-Won Seo, Bang-Bon Koo |
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| Rok vydání: | 2021 |
| Předmět: |
Adult
Male Drug Resistant Epilepsy medicine.medical_specialty Deep brain stimulation Deep Brain Stimulation medicine.medical_treatment Stimulation 03 medical and health sciences Epilepsy Atlases as Topic 0302 clinical medicine Thalamus medicine Humans In patient Retrospective Studies Seizure frequency business.industry Anterior Thalamic Nucleus Retrospective cohort study General Medicine Middle Aged medicine.disease Electrodes Implanted Treatment Outcome Anterior Thalamic Nuclei 030220 oncology & carcinogenesis Refractory epilepsy Female Radiology Tomography X-Ray Computed business 030217 neurology & neurosurgery Follow-Up Studies |
| Zdroj: | Journal of Neurosurgery. 134:1054-1063 |
| ISSN: | 1933-0693 0022-3085 |
| Popis: | OBJECTIVE The anterior thalamic nucleus (ATN) is a common target for deep brain stimulation (DBS) for the treatment of drug-refractory epilepsy. However, no atlas-based optimal DBS (active contacts) target within the ATN has been definitively identified. The object of this retrospective study was to analyze the relationship between the active contact location and seizure reduction to establish an atlas-based optimal target for ATN DBS. METHODS From among 25 patients who had undergone ATN DBS surgery for drug-resistant epilepsy between 2016 and 2018, those who had follow-up evaluations for more than 1 year were eligible for study inclusion. After an initial stimulation period of 6 months, patients were classified as responsive (≥ 50% median decrease in seizure frequency) or nonresponsive (< 50% median decrease in seizure frequency) to treatment. Stimulation parameters and/or active contact positions were adjusted in nonresponsive patients, and their responsiveness was monitored for at least 1 year. Postoperative CT scans were coregistered nonlinearly with preoperative MR images to determine the center coordinate and atlas-based anatomical localizations of all active contacts in the Montreal Neurological Institute (MNI) 152 space. RESULTS Nineteen patients with drug-resistant epilepsy were followed up for at least a year following bilateral DBS electrode implantation targeting the ATN. Active contacts located more adjacent to the center of gravity of the anterior half of the ATN volume, defined as the anterior center (AC), were associated with greater seizure reduction than those not in this location. Intriguingly, the initially nonresponsive patients could end up with much improved seizure reduction by adjusting the active contacts closer to the AC at the final postoperative follow-up. CONCLUSIONS Patients with stimulation targeting the AC may have a favorable seizure reduction. Moreover, the authors were able to obtain additional good outcomes after electrode repositioning in the initially nonresponsive patients. Purposeful and strategic trajectory planning to target this optimal region may predict favorable outcomes of ATN DBS. |
| Databáze: | OpenAIRE |
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