Authors :
Presenting Author: Asra Tanwir, MD – Mayo Clinic
Ashar Farooqi, MD – University of Kentucky
Gamal Eldin Osman, MD – Mayo Clinic
Keith Starnes, MD – Mayo Clinic, Rochester MN, USA.
Brian Lundstrom, MD PhD – Mayo clinic, Rochester, Minnesota
Gregory Worrel, MD,PhD – Mayo Clinics
Kai Miller, MD, PhD – Mayo Clinic
Jamie J Van Gompel, MD – Mayo Clinic, Rochester MN, USA.
Nicholas Gregg, MD – Mayo clinic, Rochester, Minnesota
Rationale:
Anterior nucleus of the thalamus deep brain stimulation (ANT-DBS) is an approved adjunctive therapy for drug-resistant focal epilepsy. However, data from the SANTE trial study indicate reduced effectiveness of ANT-DBS in patients with seizure networks extending beyond the Papez circuit, particularly those involving posterior cortical regions. The medial pulvinar (PuM) has recently emerged as a promising target for posterior quadrant seizure networks. Here, we present the safety and efficacy outcomes of bilateral ANT + PuM-DBS.
Methods:
This retrospective case series analyzed the clinical outcomes of six patients with posterior quadrant structural abnormalities and seizure onset localized to the posterior temporal and/or posterior quadrants. All the patients received bilateral ANT + PuM-DBS, with off-label use of a 4-lead implantable pulse generator (IPG) at our institution. The study was approved by the Mayo Clinic IRB. Patiens received ANT, PuM, or concurrent ANT/PuM stimulation. Seizure frequency was recorded at baseline and during follow-up visits, with median follow-up of 18 months. The primary outcomes were reduction in seizure frequency, and adverse effects, including both acute surgical or chronic stimulation related side effects
Results:
Neuroimaging revealed structural abnormalities in all patients: posterior predominant periventricular nodular heterotopia (n=3), band heterotopia (n=1), hemispheric malformation of cortical development (n=1), posterior quadrant encephalomalacia secondary to perinatal injury (n=1). One patient completed stereo EEG monitoring prior to DBS implantation. There were no acute surgical complications expect for postoperative pain. No patients experienced persistent stimulation related side effects; any transient side effects resolved with parameter adjustment. All six patients received ANT-DBS; five received PuM-DBS, and three received concurrent ANT/PuM stimulation. At last follow up visit, median seizure reduction was 49% with ANT only stimulation, 50% with pulvinar stimulation and 72% with combined ANT + Pulvinar. Overall, the responder rates for each group were: ANT-only stimulation: 50% (3 responders out of 6), Pulvinar stimulation: 60% (3 of 5), Combined ANT + Pulvinar: 67% (2 of 3).
Conclusions:
Our results suggest that four-lead DBS targeting ANT + PuM is well tolerated and may be an effective treatment option for patients with drug-resistant posterior temporal and/or posterior quadrant onset seizures, with posterior quadrant structural abnormalities.
Funding: No funding was received