Utility and Safety of Thalamic Nuclei Stereotactic EEG to Guide RNS Placement or Epilepsy Surgery
Abstract number :
2.464
Submission category :
9. Surgery / 9C. All Ages
Year :
2024
Submission ID :
1134
Source :
www.aesnet.org
Presentation date :
12/8/2024 12:00:00 AM
Published date :
Authors :
Presenting Author: Sarah Weatherspoon, MD – University of Tennessee Health Science Center
Karen Butler, RN – Le Bonheur Children's Hospital
Asim Choudhri, MD – University of Tennessee Health Science Center
Amy McGregor, MD – University of Tennessee Health Science Center
Basanagoud Mudigoudar, MD – University of Tennessee Health Science Center, Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital
Shalini Narayana, PhD – University of Tennessee Health Science Center, Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital
Negar Noorizadeh, PhD – University of Tennessee Health Science Center, Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital
Roozbeh Rezaie, PhD – University of Tennessee Health Science Center, Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital
Tracee Ridley-Prior, DNP, APRN, PMHNP-BC – The University of Tennesse Health Science Center
James Wheless, BScPharm, MD, FAAP, FACP, FAAN, FAES – LeBonheur Children’s Hospital
Nir Shimony, MD – University of Tennessee Health Science Center
Rationale: Drug resistant epilepsy comprises 30% of patients with epilepsy [1]. Responsive neurostimulation (RNS) offers the ability to record and interrupt seizures, with good safety and efficacy data in this patient population [2]. Studies leading to approval of deep brain stimulation identified specific thalamic nuclei as targets based on seizure semiology. Recent studies involving intracranial investigations suggest a more complex relationship between seizure type and thalamocortical networks [3]; however, direct thalamic recording via stereotactic electroencephalogram (SEEG) is not routinely performed prior to lead placement. At our center, thalamic nuclei targets are included in SEEG planning based on the pre-surgical anatomical-electrical-clinical hypothesis including anterior (ANT), centromedian (CMN), and/or pulvinar (PULV) nuclei.
Methods: A retrospective review was performed of the Le Bonheur Comprehensive Epilepsy Program Neuroscience Institute Test Database for patients who underwent SEEG placement from 2023-2024. Subjects with thalamic targets were selected and characterized based on age at implantation, number of SEEG electrodes, epilepsy type, and surgical intervention performed.
Results: Of 22 subjects with SEEG, 13 included thalamic targets, 6 of whom were < 18 years of age. 4 subjects (31%) had thalamic-only SEEG, and all progressed to RNS placement (2 bilateral PULV, 2 bilateral CMN). 9 subjects (69%) had thalamic and cortical SEEG targets. Of these, 4 progressed to RNS placement that included at least one thalamic target, 4 to resection, and 1 to laser ablation. 8 subjects with at least one thalamic SEEG placement (62%) underwent RNS placement that included at least one thalamic RNS lead placement. All subjects were implanted with the RNS system the same day of SEEG removal with no post-operative infections for either procedure; 7 subjects (87%) had detection and stimulation parameters turned on in the operating room (OR). No complications related to thalamic SEEG (e.g. intracranial hemorrhage, change in neurological exam) were observed.
Conclusions: Thalamic intracranial monitoring targets in SEEG planning resulted in thalamic-targeted treatment in 62% of subjects. No serious adverse events were seen related to this strategy. No adverse events related to initiating RNS detection and stimulation parameters in the OR were observed.
References
1. Sheng, J, et al., Drug-Resistant Epilepsy and Surgery. Curr Neuropharmacol, 2018. 16(1): p. 17-28.
2. Sharma, A, et al., Predictors of therapeutic response following thalamic neuromodulation for drug-resistant pediatric epilepsy: A systematic review and individual patient data meta-analysis. Epilepsia, 2024. 65(3): p. 542-555.
3. Gadot, R, et al., Thalamic stereoelectroencephalography in epilepsy surgery: a scoping literature review. J Neurosurg, 2022. 137(5): p. 1210-1225.
Funding: None
Surgery