Evidence for Thalamic Responsive Neurostimulation in Treatment of Adult and Pediatric Epilepsy

Stereotactic and Functional Neurosurgery

Vessell M.a· Willett A.a· Chapman B.b· Bina R.a· Ball T.a· Mutchnick I.Neimat J.S.a

Author affiliations

aDepartment of Neurosurgery, University of Louisville, Louisville, KY, USA
bBaptist Health Medical Group, Louisville, KY, USA
cNorton Children’s Hospital/Norton Neuroscience Institute, Louisville, KY, USA

Stereotact Funct Neurosurg

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Article / Publication Details

First-Page Preview

Abstract of Clinical Study

Received: July 15, 2022
Accepted: December 01, 2022
Published online: February 02, 2023

Number of Print Pages: 11
Number of Figures: 7
Number of Tables: 2

ISSN: 1011-6125 (Print)
eISSN: 1423-0372 (Online)

For additional information: https://www.karger.com/SFN

Abstract

Responsive neurostimulation (RNS) has well-established efficacy in patients with identifiable seizure foci. Emerging evidence suggests the feasibility of expanding this treatment to patients with nonfocal or multifocal epileptic profiles with thalamic targeting. Our institution performed two successful implantations of thalamic RNS (tRNS) targeting the centromedian nucleus of the thalamus (CMT), and 1-year postoperative outcomes are provided. Additionally, a literature review of all reported tRNS was conducted. Publications were excluded if they did not include demographic data and/or epilepsy outcomes at follow-up. In the literature, 19 adult and 3 pediatric cases were identified. These cases were analyzed for outcome, indications, previous operations, and surgical practice variations. Both of our patients had failed multiple previous pharmacological and neurosurgical interventions for epilepsy. Case #1 underwent tRNS with bilateral CMT stimulation. Case #2 underwent tRNS with simultaneous right CMT and right insular stimulation, although an additional lead was placed in the left CMT and left capped for potential future use. Each has achieved ≥90% reduction in seizure burden and approach seizure freedom. 71% of patients in the literature review had multifocal, bilateral, or cryptogenic seizure onset. Three patients were implanted for Lennox Gastaut (2 of 3 are pediatric). 16 patients underwent an average of 1.6 failed procedures prior to successful tRNS implantation. Taken together, the 21 adult patients reviewed have experienced an average seizure reduction of 77% at the latest follow-up. 95% of the adult patients reported in the literature experienced >50% reduction in seizure activity following tRNS and 52% experienced ≥90% reduction in seizure burden following tRNS. Pediatric patients have experienced 70–100% improvement.

© 2023 S. Karger AG, Basel

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First-Page Preview

Abstract of Clinical Study

Received: July 15, 2022
Accepted: December 01, 2022
Published online: February 02, 2023

Number of Print Pages: 11
Number of Figures: 7
Number of Tables: 2

ISSN: 1011-6125 (Print)
eISSN: 1423-0372 (Online)

For additional information: https://www.karger.com/SFN

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