Child s Nervous System, Journal Year: 2024, Volume and Issue: 40(11), P. 3709 - 3720
Published: July 26, 2024
Language: Английский
Neurobiology of Disease, Journal Year: 2023, Volume and Issue: 179, P. 106045 - 106045
Published: Feb. 20, 2023
Neuromodulation (neurostimulation) is a relatively new and rapidly growing treatment for refractory epilepsy. Three varieties are approved in the US: vagus nerve stimulation (VNS), deep brain (DBS) responsive neurostimulation (RNS). This article reviews thalamic DBS Among many sub-nuclei, epilepsy has been targeted to anterior nucleus (ANT), centromedian (CM), dorsomedial (DM) pulvinar (PULV). Only ANT FDA-approved, based upon controlled clinical trial. Bilateral of reduced seizures by 40.5% at three months phase (p = .038) 75% 5 years uncontrolled phase. Side effects related paresthesias, acute hemorrhage, infection, occasional increased seizures, usually transient on mood memory. Efficacy was best documented focal onset temporal or frontal lobe. CM may be useful generalized multifocal PULV posterior limbic seizures. Mechanisms largely unknown, but animal work points changes receptors, channels, neurotransmitters, synapses, network connectivity neurogenesis. Personalization therapies, terms seizure zone sub- individual characteristics might lead improved efficacy. Many questions remain about DBS, including candidates different types neuromodulation, targets, parameters, how minimize side deliver current noninvasively. Despite questions, neuromodulation provides opportunities treat people with not responding medicines amenable resective surgery.
Language: Английский
Citations
63
Epilepsy Research, Journal Year: 2025, Volume and Issue: 210, P. 107499 - 107499
Published: Jan. 2, 2025
Language: Английский
Citations
2
Epilepsy & Behavior, Journal Year: 2024, Volume and Issue: 160, P. 110067 - 110067
Published: Oct. 10, 2024
Language: Английский
Citations
10
Frontiers in Neurology, Journal Year: 2023, Volume and Issue: 14
Published: Sept. 8, 2023
Introduction For drug resistant epilepsy patients who are either not candidates for resective surgery or have already failed surgery, neuromodulation is a promising option. Neuromodulatory approaches include responsive neurostimulation (RNS), deep brain stimulation (DBS), and vagal nerve (VNS). Thalamocortical circuits involved in both generalized focal onset seizures. This paper explores the use of RNS centromedian nucleus thalamus (CMN) anterior thalamic (ANT) with epilepsy. Methods retrospective multicenter study from seven different centers United States. Patients that had unilateral bilateral leads implanted CMN ANT at least 6 months were included. Primary objectives to describe implant location determine changes frequency disabling seizures months, 1 year, 2 years, > years. Secondary included documenting seizure free periods, anti-seizure medication regimen changes, side effects, serious adverse events. In addition, global clinical impression scale was completed. Results Twelve one lead placed CMN, 13 ANT. The median baseline 15 per month. Overall, reduction 33% 55% 65% 74% >2 Seizure intervals 3 occurred nine patients. Most (60%, 15/25) did change medications post placement. Two events recorded, related implantation. Lastly, overall functioning seemed improve 88% showing improvement on scale. Discussion Meaningful observed suffer thalamus. remained their pre-operative regimen. device well tolerated few effects. There rare showed an scores.
Language: Английский
Citations
17
Epilepsy Research, Journal Year: 2024, Volume and Issue: 205, P. 107407 - 107407
Published: July 6, 2024
Language: Английский
Citations
8
Epilepsia, Journal Year: 2024, Volume and Issue: 65(3), P. 542 - 555
Published: Jan. 24, 2024
Abstract We sought to perform a systematic review and individual participant data meta‐analysis identify predictors of treatment response following thalamic neuromodulation in pediatric patients with medically refractory epilepsy. Electronic databases (MEDLINE, Ovid, Embase, Cochrane) were searched, no language or restriction, studies reporting seizure outcomes populations deep brain stimulation (DBS) responsive neurostimulation (RNS) implantation nuclei. Studies featuring primary secondary generalized drug‐resistant epilepsy included. Response therapy was defined as >50% reduction frequency from baseline. Of 417 citations, 21 articles on 88 participants eligible. Mean age at 13.07 ± 3.49 years. Fifty (57%) underwent DBS, 38 (43%) RNS. Sixty (68%) implanted centromedian nucleus 23 (26%) anterior nucleus, five (6%) had both targets implanted. Seventy‐four (84%) bilaterally. The median time last follow‐up 12 months (interquartile range = 6.75–26.25). Sixty‐nine percent achieved treatment. Age, target, modality, laterality significant association univariate logistic regression. Until gains widespread approval for use patients, efficacy will continue be limited small retrospective cohorts case series. inherent bias these can overcome by using data. Thalamic appears safe effective Larger, prolonged prospective, multicenter are warranted further evaluate the DBS over RNS this patient population where resection curative intent is not option.
Language: Английский
Citations
5
Therapeutic Advances in Neurological Disorders, Journal Year: 2023, Volume and Issue: 16
Published: Jan. 1, 2023
Background: Epilepsy is a widespread neurologic disorder and almost one-third of patients suffer from drug-resistant epilepsy (DRE). Neuromodulation targeting the centromediannucleus thalamus (CM) has been showing promising results for with generalized DRE who are not surgical candidates. Recently, effect CM- deep brain stimulation (DBS) in was investigated Electrical Stimulation Thalamus Lennox–Gastaut phenotype (ESTEL) trial, monocentric randomized-controlled study. The same authors described ‘cold-spot’ ‘sweet-spot’, which defined as volume yielding least best clinical response, respectively. However, it remains unclear structural connections may contribute to anti-seizure stimulation. Objective: We differences connectivity among CM, sweet-spot cold-spot. Furthermore, we tried validate our cohort underwent CM-DBS or CM-RNS (responsive neurostimulation). hypothesized that would share similar responder patients. Methods: By using software FMRIB Software Library (FSL), probabilistic tractography performed on 100 subjects Human Connectome Project calculate probability whole cold-spot 45 cortical subcortical areas. Results three seeds were compared multivariate analysis variance (MANOVA). Similarly, volumes tissue activated (VTAs) eight investigated. Patients divided into responders non-responders based degree reduction seizure frequency, mean probabilities similarly between two groups. Results: demonstrated significantly higher ( p < 0.001) precentral gyrus, superior frontal cerebellum than CM Responder displayed both ipsilateral = 0.011) contralateral 0.04) non-responders. Conclusion: Cerebellar seem beneficial effects CM-neuromodulation epilepsy.
Language: Английский
Citations
13
Pediatric Neurology, Journal Year: 2023, Volume and Issue: 143, P. 106 - 112
Published: March 9, 2023
Language: Английский
Citations
12
Epilepsia, Journal Year: 2024, Volume and Issue: 65(6)
Published: April 16, 2024
Abstract In patients with drug‐resistant epilepsy (DRE) who are not candidates for resective surgery, various thalamic nuclei, including the anterior, centromedian, and pulvinar have been extensively investigated as targets neuromodulation. However, therapeutic effects of different neuromodulation on types well understood. Here, we present a 32‐year‐old patient multifocal bilateral temporoparieto‐occipital malformations cortical development (MCDs) underwent stereoelectroencephalographic (SEEG) recordings aforementioned three nuclei bilaterally. The change in rate interictal epileptiform discharges (IEDs) from baseline were compared temporal, central, parietal, occipital regions after direct electrical stimulation (DES) each nucleus. A significant decrease IEDs (33% baseline) posterior quadrant was noted ipsilateral contralateral hemisphere following DES pulvinar. scoping review also performed to better understand current standpoint treatment DRE. effect can differ among epileptogenic zones (EZs). EZs extensive MCDs, personalized targeting could be achieved through SEEG electrodes.
Language: Английский
Citations
4
Epilepsia, Journal Year: 2024, Volume and Issue: 65(8)
Published: June 7, 2024
Abstract Neuromodulation therapies offer an efficacious treatment alternative for patients with drug‐resistant epilepsy (DRE), particularly those unlikely to benefit from surgical resection. Here we present our retrospective single‐center case series of pediatric‐onset DRE who underwent responsive neurostimulation (RNS) depth electrode implantation targeting the bilateral centromedian nucleus (CM) thalamus between October 2020 and 2022. Sixteen were identified; seizure outcomes, programming parameters, complications at follow‐up reviewed. The median age was 13 years (range 3.6–22). Six (38%) younger than 12 time implantation. Ictal electroencephalography (EEG) patterns during patients’ most disabling seizures reliably detected. Ten (62%) achieved 50% or greater reduction in frequency a 1.3 0.6–2.6) follow‐up. Eight (50%) experienced sensorimotor side effects, three (19%) had superficial pocket infection, prompting removal RNS device. Side effects stimulation mostly monopolar‐cathodal configuration alleviated change bipolar low‐frequency stimulation. Closed‐loop using CM is feasible useful therapy DRE.
Language: Английский
Citations
4