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Electrical stimulation of the anterior nucleus of thalamus for treatment of refractory epilepsy
Author(s) -
Fisher Robert,
Salanova Vicenta,
Witt Thomas,
Worth Robert,
Henry Thomas,
Gross Robert,
Oommen Kalarickal,
Osorio Ivan,
Nazzaro Jules,
Labar Douglas,
Kaplitt Michael,
Sperling Michael,
Sandok Evan,
Neal John,
Handforth Adrian,
Stern John,
DeSalles Antonio,
Chung Steve,
Shetter Andrew,
Bergen Donna,
Bakay Roy,
Henderson Jaimie,
French Jacqueline,
Baltuch Gordon,
Rosenfeld William,
Youkilis Andrew,
Marks William,
Garcia Paul,
Barbaro Nicolas,
Fountain Nathan,
Bazil Carl,
Goodman Robert,
McKhann Guy,
Babu Krishnamurthy K.,
Papavassiliou Steven,
Epstein Charles,
Pollard John,
Tonder Lisa,
Grebin Joan,
Coffey Robert,
Graves Nina
Publication year - 2010
Publication title -
epilepsia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.687
H-Index - 191
eISSN - 1528-1167
pISSN - 0013-9580
DOI - 10.1111/j.1528-1167.2010.02536.x
Subject(s) - thalamus , stimulation , epilepsy , deep brain stimulation , anesthesia , medicine , adverse effect , thalamic stimulator , electroencephalography , neurological disorder , randomized controlled trial , central nervous system disease , psychology , surgery , neuroscience , psychiatry , disease , parkinson's disease
Summary Purpose: We report a multicenter, double‐blind, randomized trial of bilateral stimulation of the anterior nuclei of the thalamus for localization‐related epilepsy. Methods: Participants were adults with medically refractory partial seizures, including secondarily generalized seizures. Half received stimulation and half no stimulation during a 3‐month blinded phase; then all received unblinded stimulation. Results: One hundred ten participants were randomized. Baseline monthly median seizure frequency was 19.5. In the last month of the blinded phase the stimulated group had a 29% greater reduction in seizures compared with the control group, as estimated by a generalized estimating equations (GEE) model (p = 0.002). Unadjusted median declines at the end of the blinded phase were 14.5% in the control group and 40.4% in the stimulated group. Complex partial and “most severe” seizures were significantly reduced by stimulation. By 2 years, there was a 56% median percent reduction in seizure frequency; 54% of patients had a seizure reduction of at least 50%, and 14 patients were seizure‐free for at least 6 months. Five deaths occurred and none were from implantation or stimulation. No participant had symptomatic hemorrhage or brain infection. Two participants had acute, transient stimulation‐associated seizures. Cognition and mood showed no group differences, but participants in the stimulated group were more likely to report depression or memory problems as adverse events. Discussion: Bilateral stimulation of the anterior nuclei of the thalamus reduces seizures. Benefit persisted for 2 years of study. Complication rates were modest. Deep brain stimulation of the anterior thalamus is useful for some people with medically refractory partial and secondarily generalized seizures.