Deep brain stimulation targets in epilepsy: Systematic review and meta-analysis of anterior and centromedian thalamic nuclei and hippocampus
Artur Vetkas 1 2, Anton Fomenko 1 3, Jürgen Germann 1, Can Sarica 1, Christian Iorio-Morin 4, Nardin Samuel 1, Kazuaki Yamamoto 1, Vanessa Milano 1, Cletus Cheyuo 1, Ajmal Zemmar 5, Gavin Elias 1, Alexandre Boutet 1 6, Aaron Loh 1, Brendan Santyr 1 7, Dave Gwun 1, Jordy Tasserie 1, Suneil K Kalia 1 8, Andres M Lozano 1 8
Affiliations expand
- PMID: 34981509
- DOI: 10.1111/epi.17157
Erratum in
- Erratum.[No authors listed]Epilepsia. 2022 Jun;63(6):1605. doi: 10.1111/epi.17256. Epub 2022 Apr 19.PMID: 35441369 No abstract available.
Abstract
Deep brain stimulation (DBS) is a neuromodulatory treatment used in patients with drug-resistant epilepsy (DRE). The primary goal of this systematic review and meta-analysis is to describe recent advancements in the field of DBS for epilepsy, to compare the results of published trials, and to clarify the clinical utility of DBS in DRE. A systematic literature search was performed by two independent authors. Forty-four articles were included in the meta-analysis (23 for anterior thalamic nucleus [ANT], 8 for centromedian thalamic nucleus [CMT], and 13 for hippocampus) with a total of 527 patients. The mean seizure reduction after stimulation of the ANT, CMT, and hippocampus in our meta-analysis was 60.8%, 73.4%, and 67.8%, respectively. DBS is an effective and safe therapy in patients with DRE. Based on the results of randomized controlled trials and larger clinical series, the best evidence exists for DBS of the anterior thalamic nucleus. Further randomized trials are required to clarify the role of CMT and hippocampal stimulation. Our analysis suggests more efficient deep brain stimulation of ANT for focal seizures, wider use of CMT for generalized seizures, and hippocampal DBS for temporal lobe seizures. Factors associated with clinical outcome after DBS for epilepsy are electrode location, stimulation parameters, type of epilepsy, and longer time of stimulation. Recent advancements in anatomical targeting, functional neuroimaging, responsive neurostimulation, and sensing of local field potentials could potentially lead to improved outcomes after DBS for epilepsy and reduced sudden, unexpected death of patients with epilepsy. Biomarkers are needed for successful patient selection, targeting of electrodes and optimization of stimulation parameters.
Keywords: ANT; CMT; DBS; focal; seizures.
© 2022 International League Against Epilepsy.
Comment in
- Deep brain stimulation targets in epilepsy: Systematic review and meta-analysis of anterior and centromedian thalamic nuclei and hippocampus.Al-Kraimeen LM, Ababneh O, Yassin A.Epilepsia. 2022 Jul;63(7):1883-1884. doi: 10.1111/epi.17270. Epub 2022 May 16.PMID: 35485951 No abstract available.
- Response: Deep brain stimulation targets in epilepsy: Systematic review and meta-analysis of anterior and centromedian thalamic nuclei and hippocampus.Vetkas A, Fomenko A, Germann J, Sarica C, Iorio-Morin C, Samuel N, Yamamoto K, Milano V, Cheyuo C, Zemmar A, Elias G, Boutet A, Loh A, Santyr B, Gwun D, Tasserie J, Kalia SK, Lozano AM.Epilepsia. 2022 Jul;63(7):1885-1886. doi: 10.1111/epi.17272. Epub 2022 May 16.PMID: 35514031 No abstract available.
