Abstracts

Stimulation of the Thalamus for Arousal Restoral in Temporal Lobe Epilepsy (START) Clinical Trial

Abstract number : 2.436
Submission category : 4. Clinical Epilepsy / 4C. Clinical Treatments
Year : 2022
Submission ID : 2232902
Source : www.aesnet.org
Presentation date : 12/4/2022 12:00:00 PM
Published date : Nov 22, 2022, 05:28 AM

Authors :
Taruna Yadav, PhD – Yale University; Vaclav Kremen, PhD – Mayo Clinic; Catherine Doucet, NA – Yale University; Kristine DaCosta, NA – Yale University; Maxime Oriol, NA – Yale University; Christopher Benjamin, PhD – Yale University; Kate Christison-Lagay, PhD – Yale University; Eyiyemisi Damisah, MD – Yale University; Allyson Derry, NA – Yale University; Abhijeet Gummadavelli, MD PhD – Yale University; Tyler Hamilton, NA – Yale University; Lawrence Hirsch, MD – Yale University; Patrice Lauture, NA – Yale University; Bogdan Patedakis Litvinov, MD – Yale University; Dennis Spencer, MD – Yale University; Kimberly Bailey, NA – Mayo Clinic; Karla Crockett, NA – Mayo Clinic; Starr Guzman, NA – Mayo Clinic; Vladimir Sladky, NA – Mayo Clinic; Delana Weis, NA – Mayo Clinic; Krzystof Bujarski, NA – Dartmouth-Hitchcock Medical Center; Charlotte Jeffreys, NA – Dartmouth-Hitchcock Medical Center; Anastasia Kanishcheva, NA – Dartmouth-Hitchcock Medical Center; Grant Moncrief, NA – Dartmouth-Hitchcock Medical Center; Robert Roth, NA – Dartmouth-Hitchcock Medical Center; George Thomas, MD – Dartmouth-Hitchcock Medical Center; Jonathan Baker, PhD – Weill Cornell Medical School; Eun Young Choi, PhD – Stanford University Medical Center; Jaimie Henderson, MD – Stanford University Medical Center; Matthew Hook, NA – University of Florida; Irina Korytov, NA – University of Florida; Kyle O’Sullivan, NA – University of Utah; Brian Rutt, PhD – Stanford University Medical Center; Joseph Giacino, PhD – Harvard Medical School; Benjamin Brinkmann, PhD – Mayo Clinic; George Culler, MD – Dartmouth-Hitchcock Medical Center; Nicholas Gregg, MD – Mayo Clinic; Brian Lundstrom, MD PhD – Mayo Clinic; Imran Quraishi, MD PhD – Yale University; Joshua Aronson, MD – Dartmouth-Hitchcock Medical Center; Jason Gerrard, MD PhD – Yale University; Jamie Van Gompel, MD – Mayo Clinic; Christopher Butson, PhD – University of Florida; Nicholas Schiff, MD – Weill Cornell Medical School; Barbara Jobst, MD PhD – Dartmouth-Hitchcock Medical Center; Gregory Worrell, MD PhD – Mayo Clinic; Hal Blumenfeld, MD PhD – Yale University

This is a Late Breaking abstract

Rationale: Impaired consciousness in temporal lobe seizures may be related to depressed thalamocortical arousal. Our goals were:  (1) to investigate the relationship between electrophysiological severity of seizures and impaired consciousness, and (2) to investigate deep brain stimulation of the thalamic intralaminar central lateral nucleus (CL) to increase conscious awareness during temporal lobe seizures.

Methods: We studied 15 patients with mesial temporal lobe epilepsy undergoing intracranial EEG (icEEG). Retrospective video review of behavior distinguished seizures with and without impaired consciousness. Intracranial EEG power in the mesial temporal lobe contacts was compared for seizures with impaired vs. spared consciousness. Six patients with medically refractory temporal lobe epilepsy are being recruited for the START clinical trial. Behavioral testing of memory and verbal and nonverbal responsiveness is conducted with a wearable Automatic Response Testing in Epilepsy (ARTiE) Watch. The thalamic CL nucleus is targeted with white matter null MRI. The Summit RC+STM (an investigational device donated by Medtronic) delivers responsive stimulation (1) to the hippocampi, aimed at stopping epileptiform activity, and (2) to bilateral thalamic CL stimulation with the goal of improving ictal and postictal consciousness in cases where seizures are not stopped by hippocampal stimulation.

Results: Quantitative analysis of mesial temporal icEEG data in the 15 patients showed significant increases in power across all frequency bands during seizures with vs. without impaired consciousness (p < 0.05). For patients implanted with the Summit RC+STM system (Medtronic), we found that bilateral CL stimulation during the interictal period produced behavioral and electrophysiological arousal from N2 or N3 sleep, demonstrating the efficacy of stimulation. ARTiE Watch behavioral testing shows reduced mean scores of 2.4 ± 0.8 during seizures compared to baseline scores of 2.9 ± 0.2 (p < 0.001, Wilcoxon rank-sum test). Ongoing testing will investigate the efficacy of thalamic CL stimulation to restore consciousness during and following seizures vs. sham control.
Clinical Epilepsy