Katrina L Dell1, Mark J Cook1,2, Matias I Maturana3. 1. Department of Medicine, St. Vincent's Hospital, University of Melbourne, Level 4, 29 Regent Street, St Vincent's Hospital, Fitzroy, Victoria, 3065, Australia. 2. Graeme Clark Institute, University of Melbourne, Parkville, Victoria, Australia. 3. Department of Medicine, St. Vincent's Hospital, University of Melbourne, Level 4, 29 Regent Street, St Vincent's Hospital, Fitzroy, Victoria, 3065, Australia. matiasim@unimelb.edu.au.
Abstract
PURPOSE OF REVIEW: Two large-scale controlled clinical trials have provided Class I evidence for the benefit of deep brain stimulation (DBS) as a therapy for refractory epilepsy. However, the efficacy has been variable, with some patients not achieving any improvement in their seizure control. This disparity could be the result of suboptimal stimulation parameters/electrodes or alternatively a difference in the type of seizures being treated. This review presents the most recent clinical results with a focus on two major targets for DBS, the anterior nucleus of the thalamus (ANT) and the hippocampus. We detail the etiologies where DBS might work best, and provide evidence for the use of recorded neural responses for the optimization of stimulation parameters and closed-loop control of devices. RECENT FINDINGS: Stimulation of the hippocampus may work well for both focal and generalized seizures, whereas ANT stimulation may be best for focal seizures only. Studies have demonstrated that changes in stimulation-evoked response shape can be used as a biomarker for stimulation efficacy. Furthermore, new biomarkers have been identified that could be used for closed-loop stimulation. Improvements in patient screening and stimulation optimization are needed for patients to achieve optimal seizure control. Furthermore, therapy should be adjusted to suit individual patient needs. Recording evoked responses during the application of DBS could be used to measure the effectiveness of DBS and titrate stimulation as needed.
PURPOSE OF REVIEW: Two large-scale controlled clinical trials have provided Class I evidence for the benefit of deep brain stimulation (DBS) as a therapy for refractory epilepsy. However, the efficacy has been variable, with some patients not achieving any improvement in their seizure control. This disparity could be the result of suboptimal stimulation parameters/electrodes or alternatively a difference in the type of seizures being treated. This review presents the most recent clinical results with a focus on two major targets for DBS, the anterior nucleus of the thalamus (ANT) and the hippocampus. We detail the etiologies where DBS might work best, and provide evidence for the use of recorded neural responses for the optimization of stimulation parameters and closed-loop control of devices. RECENT FINDINGS: Stimulation of the hippocampus may work well for both focal and generalized seizures, whereas ANT stimulation may be best for focal seizures only. Studies have demonstrated that changes in stimulation-evoked response shape can be used as a biomarker for stimulation efficacy. Furthermore, new biomarkers have been identified that could be used for closed-loop stimulation. Improvements in patient screening and stimulation optimization are needed for patients to achieve optimal seizure control. Furthermore, therapy should be adjusted to suit individual patient needs. Recording evoked responses during the application of DBS could be used to measure the effectiveness of DBS and titrate stimulation as needed.
Entities:
Keywords:
Anterior nucleus of the thalamus; Circuit of Papez; Deep brain stimulation; Epilepsy; Hippocampus; Stimulation parameters
Authors: Wei-Chih Chang; Jan Kudlacek; Jaroslav Hlinka; Jan Chvojka; Michal Hadrava; Vojtech Kumpost; Andrew D Powell; Radek Janca; Matias I Maturana; Philippa J Karoly; Dean R Freestone; Mark J Cook; Milan Palus; Jakub Otahal; John G R Jefferys; Premysl Jiruska Journal: Nat Neurosci Date: 2018-11-26 Impact factor: 24.884
Authors: Y Maki; J Natsume; Y Ito; Y Okai; E Bagarinao; H Yamamoto; S Ogaya; T Takeuchi; T Fukasawa; F Sawamura; T Mitsumatsu; S Maesawa; R Saito; Y Takahashi; H Kidokoro Journal: AJNR Am J Neuroradiol Date: 2022-09-22 Impact factor: 4.966