Deep Brain Stimulation in Epilepsy : A Role for Modulation of the Mammillothalamic Tract in Seizure Control?
Copyright © 2020 by the Congress of Neurological Surgeons..
BACKGROUND: Deep brain stimulation of the anterior nucleus of the thalamus (ANT-DBS) can improve seizure control for patients with drug-resistant epilepsy (DRE). Yet, one cannot overlook the high discrepancy in efficacy among patients, possibly resulting from differences in stimulation site.
OBJECTIVE: To test the hypothesis that stimulation at the junction of the ANT and mammillothalamic tract (ANT-MTT junction) increases seizure control.
METHODS: The relationship between seizure control and the location of the active contacts to the ANT-MTT junction was investigated in 20 patients treated with ANT-DBS for DRE. Coordinates and Euclidean distance of the active contacts relative to the ANT-MTT junction were calculated and related to seizure control. Stimulation sites were mapped by modelling the volume of tissue activation (VTA) and generating stimulation heat maps.
RESULTS: After 1 yr of stimulation, patients had a median 46% reduction in total seizure frequency, 50% were responders, and 20% of patients were seizure-free. The Euclidean distance of the active contacts to the ANT-MTT junction correlates to change in seizure frequency (r2 = 0.24, P = .01) and is ∼30% smaller (P = .015) in responders than in non-responders. VTA models and stimulation heat maps indicate a hot-spot at the ANT-MTT junction for responders, whereas non-responders had no evident hot-spot.
CONCLUSION: Stimulation at the ANT-MTT junction correlates to increased seizure control. Our findings suggest a relationship between the stimulation site and therapy response in ANT-DBS for epilepsy with a potential role for the MTT. DBS directed at white matter merits further exploration for the treatment of epilepsy.
| Errataetall: |
CommentIn: Neurosurgery. 2021 Feb 16;88(3):E283-E284. - PMID 33428768 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2020 |
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| Erschienen: |
2020 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:87 |
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| Enthalten in: |
Neurosurgery - 87(2020), 3 vom: 01. Sept., Seite 602-610 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Schaper, Frédéric L W V J [VerfasserIn] |
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| Links: |
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| Themen: |
DRE |
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| Anmerkungen: |
Date Completed 25.01.2021 Date Revised 05.11.2021 published: Print CommentIn: Neurosurgery. 2021 Feb 16;88(3):E283-E284. - PMID 33428768 Citation Status MEDLINE |
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| doi: |
10.1093/neuros/nyaa141 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM310044138 |
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| 100 | 1 | |a Schaper, Frédéric L W V J |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Deep Brain Stimulation in Epilepsy |b A Role for Modulation of the Mammillothalamic Tract in Seizure Control? |
| 264 | 1 | |c 2020 | |
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| 500 | |a Date Completed 25.01.2021 | ||
| 500 | |a Date Revised 05.11.2021 | ||
| 500 | |a published: Print | ||
| 500 | |a CommentIn: Neurosurgery. 2021 Feb 16;88(3):E283-E284. - PMID 33428768 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2020 by the Congress of Neurological Surgeons. | ||
| 520 | |a BACKGROUND: Deep brain stimulation of the anterior nucleus of the thalamus (ANT-DBS) can improve seizure control for patients with drug-resistant epilepsy (DRE). Yet, one cannot overlook the high discrepancy in efficacy among patients, possibly resulting from differences in stimulation site | ||
| 520 | |a OBJECTIVE: To test the hypothesis that stimulation at the junction of the ANT and mammillothalamic tract (ANT-MTT junction) increases seizure control | ||
| 520 | |a METHODS: The relationship between seizure control and the location of the active contacts to the ANT-MTT junction was investigated in 20 patients treated with ANT-DBS for DRE. Coordinates and Euclidean distance of the active contacts relative to the ANT-MTT junction were calculated and related to seizure control. Stimulation sites were mapped by modelling the volume of tissue activation (VTA) and generating stimulation heat maps | ||
| 520 | |a RESULTS: After 1 yr of stimulation, patients had a median 46% reduction in total seizure frequency, 50% were responders, and 20% of patients were seizure-free. The Euclidean distance of the active contacts to the ANT-MTT junction correlates to change in seizure frequency (r2 = 0.24, P = .01) and is ∼30% smaller (P = .015) in responders than in non-responders. VTA models and stimulation heat maps indicate a hot-spot at the ANT-MTT junction for responders, whereas non-responders had no evident hot-spot | ||
| 520 | |a CONCLUSION: Stimulation at the ANT-MTT junction correlates to increased seizure control. Our findings suggest a relationship between the stimulation site and therapy response in ANT-DBS for epilepsy with a potential role for the MTT. DBS directed at white matter merits further exploration for the treatment of epilepsy | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a DRE | |
| 650 | 4 | |a Drug-resistant epilepsy | |
| 650 | 4 | |a Mammillothalamic tract | |
| 650 | 4 | |a Neuromodulation | |
| 650 | 4 | |a Thalamus | |
| 650 | 4 | |a White matter stimulation | |
| 700 | 1 | |a Plantinga, Birgit R |e verfasserin |4 aut | |
| 700 | 1 | |a Colon, Albert J |e verfasserin |4 aut | |
| 700 | 1 | |a Wagner, G Louis |e verfasserin |4 aut | |
| 700 | 1 | |a Boon, Paul |e verfasserin |4 aut | |
| 700 | 1 | |a Blom, Nadia |e verfasserin |4 aut | |
| 700 | 1 | |a Gommer, Erik D |e verfasserin |4 aut | |
| 700 | 1 | |a Hoogland, Govert |e verfasserin |4 aut | |
| 700 | 1 | |a Ackermans, Linda |e verfasserin |4 aut | |
| 700 | 1 | |a Rouhl, Rob P W |e verfasserin |4 aut | |
| 700 | 1 | |a Temel, Yasin |e verfasserin |4 aut | |
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