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Deep Brain Stimulation for Epilepsy: Evidence for Limbic Network Disruption via Chronic Anterior Nucleus of the Thalamus and Hippocampus Stimulation

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Deep Brain Stimulation for Neurological Disorders

Abstract

Epilepsy is a chronic seizure condition affecting 50 million people worldwide, with 20 % refractory to medical therapy. Some of these patients are poor candidates for surgical resection of an epileptogenic focus. Since the 1980s, variably successful attempts to disrupt or prevent refractory seizures using DBS have capitalized on predictable limbic cortical–subcortical pathways of seizure propagation. Two “nodes” in this circuit have been recently targeted with high-frequency electrical stimulation in order to halt seizure activity: the anterior nucleus of the thalamus (ANT) and the hippocampus. In 2010 the anticipated results of the first multi-center, double-blind trial of DBS for epilepsy, the SANTE trial, reported a 29 % greater reduction in seizure frequency compared to controls after 3 months of ANT stimulation. Hippocampus stimulation has also seen a recent surge in clinical trials that suggest an ability to both reduce seizure frequency in patients with hippocampal epileptogenic foci and cause fewer cognitive side effects than does surgical resection, a major contraindication to mesial temporal lobe surgery. However, a large, blinded and controlled trial has yet to be completed. In this chapter we review relevant limbic circuitry, discuss physiological and clinical evidence for ANT and hippocampal stimulation for seizure reduction and outline the excellent safety profile of DBS in general. We also present our DBS implantation protocol at the University of Pennsylvania.

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Authors and Affiliations

  1. Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA

    Paul Koch MD & Gordon Baltuch MD, PhD

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  1. Paul Koch MD
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  2. Gordon Baltuch MD, PhD
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Correspondence to Paul Koch MD .

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Editors and Affiliations

  1. Department of Neurological Surgery, Koyo Hospital, Wakayama, Wakayama, Japan

    Toru Itakura

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Koch, P., Baltuch, G. (2015). Deep Brain Stimulation for Epilepsy: Evidence for Limbic Network Disruption via Chronic Anterior Nucleus of the Thalamus and Hippocampus Stimulation. In: Itakura, T. (eds) Deep Brain Stimulation for Neurological Disorders. Springer, Cham. https://doi.org/10.1007/978-3-319-08476-3_14

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  • DOI: https://doi.org/10.1007/978-3-319-08476-3_14

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-08475-6

  • Online ISBN: 978-3-319-08476-3

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