Anterior thalamic nucleus deep brain stimulation for refractory epilepsy: Preliminary results in our first 5 patients

• Published in: Neuro-chirurgie Vol. 66; no. 4; pp. 252 - 257
• Main Authors: Tassigny, D., Soler-Rico, M., Delavallée, M., Santos, S.F., El Tahry, R., Raftopoulos, C.
• Format: Journal Article
• Language: English
• Published: France Elsevier Masson SAS 01.08.2020
• Subjects: Adult; Anterior Thalamic Nuclei - diagnostic imaging; Anterior Thalamic Nuclei - surgery; Anterior thalamic nucleus; Deep brain stimulation; Deep Brain Stimulation - methods; Drug Resistant Epilepsy - surgery; Electroencephalography; Female; First cases; Fluoroscopy; Humans; Imaging, Three-Dimensional; Magnetic Resonance Imaging; Male; Mammillary Bodies - diagnostic imaging; Mammillary Bodies - surgery; Middle Aged; Multimodal Imaging; Neurosurgical Procedures - methods; Postoperative Complications - epidemiology; Prospective Studies; Refractory epilepsy; Stereotaxic Techniques; Surgery, Computer-Assisted - methods; Treatment Outcome; Refractory epilepsy; First cases; Deep brain stimulation; Anterior thalamic nucleus
• ISSN: 0028-3770; 1773-0619
• DOI: 10.1016/j.neuchi.2020.03.001

Deep brain stimulation (DBS) of the anterior thalamic nucleus (ATN) has been recognized to be an efficient treatment of refractory epilepsy (RE). However, ATN targeting is difficult and up to 8% of lead misplacement is reported. Our objective is to report our surgical procedure based on MRI targeting and our clinical results. Our first five consecutive patients (4M, 1F, mean age: 42.8 years) treated by DBS of ATN between March and October 2016 were included. The mean duration of their epilepsy was 29 years. Four patients had already vagal nerve stimulation and 2 mammillary body stimulation. Stereotactic coordinates were calculated using distal segment of mammillothalamic tract as landmark. All procedures were performed under general anesthesia with intraoperative control of lead position using a robotic 3D fluoroscopy and image fusion with the preoperative MRI. No complications or lead misplacement was observed. The mean 3D distance between the planned target and location of the lead was 1.8 mm. Each patient was followed up at least one year (15+3months). The stimulation parameters were: 140Hz, 90m/s and 5 Volts with one minute ON/five minutes OFF cycle. The mean reduction of seizure frequency reached −52.5% (+32.2) at 6-months but decreased to −24.5% (+65.7) at the last follow-up due to some adverse events not related to stimulation. No complication, no lead misplacement and the improvement in our first patients, previously not help by multiple medications or surgeries, are encouraging.