Responsive Neurostimulation of the Anterior Thalamic Nuclei in Refractory Genetic Generalized Epilepsy: A Case Series. Brain Sci 2023 Feb 14;13(2)
Date
02/26/2023Pubmed ID
36831867Pubmed Central ID
PMC9954640DOI
10.3390/brainsci13020324Scopus ID
2-s2.0-85148880498 (requires institutional sign-in at Scopus site) 2 CitationsAbstract
Genetic generalized epilepsies (GGEs) are thought to represent disorders of thalamocortical networks. There are currently no well-established non-pharmacologic treatment options for patients with drug-resistant GGE. NeuroPace's Responsive Neurostimulation (RNS) System was approved by the United States Food and Drug Administration to treat focal seizures with up to two ictal foci. We report on three adults with drug-resistant GGE who were treated with thalamic RNS. Given the severity of their epilepsies and the potential ictogenic role of the thalamus in the pathophysiology of GGE, the RNS System was palliatively implanted with leads in the bilateral anterior thalamic nuclei (ANT) of these patients. The ANT was selected because it was demonstrated to be a safe target. We retrospectively evaluated metrics including seizure frequency over 18-32 months. One patient required explantation due to infection. The other two patients were clinical responders. By the end of the observation period reported here, one patient was seizure-free for over 9 months. All three self-reported an improved quality of life. The clinical response observed in these patients provides 'proof-of-principle' that GGE may be treatable with responsive thalamic stimulation. Our results support proceeding to a larger study investigating the efficacy and safety of thalamic RNS in drug-resistant GGE.
Author List
O'Donnell CM, Swanson SJ, Carlson CE, Raghavan M, Pahapill PA, Anderson CTAuthors
Chad Carlson MD Professor in the Neurology department at Medical College of WisconsinPeter A. Pahapill MD, PhD Professor in the Neurosurgery department at Medical College of Wisconsin
Manoj Raghavan MD, PhD Professor in the Neurology department at Medical College of Wisconsin
Sara J. Swanson PhD Chief, Professor in the Neurology department at Medical College of Wisconsin
