Abstracts

Feasibility, Safety, and Early Efficacy of 4-lead Deep Brain Stimulation of the Thalamus

Abstract number : 2.43
Submission category : 9. Surgery / 9A. Adult
Year : 2024
Submission ID : 573
Source : www.aesnet.org
Presentation date : 12/8/2024 12:00:00 AM
Published date :

Authors :
Roger Chang, MD, PhD – Stanford University School of Medicine
Paul McGeoch, MD – Stanford University School of Medicine
Zoe Lusk, BS – Stanford University School of Medicine
Kevin Graber, MD – Stanford University
Josef Parvizi, MD,PHD – Stanford Comprehensive Epilepsy Center Stanford University Medical Center
Robert Fisher, MD, PhD – Stanford University School of Medicine
Presenting Author: Vivek Buch, MD – Stanford University


Rationale: Anti-seizure medications have been utilized to treat the 1% of the world’s population with epilepsy; but one-third remain refractory despite the development of many new anti-seizure medications. For patients with medically refractory epilepsy, neuromodulation, particularly with deep brain stimulation (DBS) of the thalamus is an attractive and emerging approach. While several studies have investigated the clinical application of stimulating individual thalamic nuclei, including anterior nucleus of the thalamus (ANT), centromedian (CM), pulvinar (PLV), and dorosmedian nucleus (DM), in certain patients, the seizure network may be too broad or diffuse, involving multiple thalamic nuclei or nuclei not classically attributed to the seizure-onset zone. A unique approach of simultaneously targeting two or more of these nuclei, which we call multi-nodal DBS, has not been fully explored for these cases.


Methods: During multidisciplinary surgical case conference discussions at Stanford University, 13 patients (6 females, 7 males, average epilepsy duration 23.4 months) were deemed to be reasonable candidates for multi-nodal approach. These patients had recordings (including stereotactic intracranial EEG), which identified seizure onset zones that were generalized, multifocal, regional, or non-localizable. Utilizing either robotic or frame-based technique, we placed electrodes in an initial cohort of 13 patients over 2 years, 4 DBS leads into bilateral (1) ANT and PLV, (2) ANT and CM, or (3) DM and CM. These 4 leads were all connected to a single 32 channel stimulator (Boston Scientific, Marlborough, MA). Under an IRB protocol, chart review was performed to assess the primary outcomes of this study, post-operative complications and percent change in seizure frequency.


Results: Post-operatively there were no hemorrhages and no changes to baseline neurological function. These patients were typically discharged on post-operative day 1. Among 9 cases with follow-up after thalamic stimulation was turned on for 6 to 21 months (average follow-up 13.4 months), 8 (89%) demonstrated substantial improvement in seizure-control, with a mean seizure frequency reduction of 76% (median 95%, standard deviation 35%). Two patients became seizure-free (Engel Class IA), both for 6 months. One patient (11%) did not respond to therapy. Two patients (15% of total 13 patients) had wound-related complications that required re-operation with one (8% of total 13 patients) that subsequently required device explantation. One patient (8% of total 13 patients) went into non-convulsive status after not immediately receiving antiseizure medications post-op given no enteral access. One month later this patient passed away due to a Right frontal intraparenchymal and subarachnoid hemorrhage.


Conclusions: Overall, this initial cohort demonstrates the feasibility and safety of multi-nodal thalamic DBS for medically refractory epilepsy, with already early findings of substantial improvement in seizure control. Continued studies with multi-nodal DBS will be necessary to confirm these promising exploratory results.


Funding: None

Surgery