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Anterior thalamic nucleus deep brain Stimulation (DBS) for drug-resistant complex partial seizures (CPS) with or without generalization: long-term evaluation and predictive outcome

  • Clinical Article - Functional
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Abstract

Background

Drug-resistant epileptic patients account for 40 % of cases of epilepsy. Consequently, specific therapeutic options could be surgical resection or, if not indicated, deep brain stimulation (DBS). The aim of this study is to review data from patients affected by drug-resistant complex partial epilepsy with or without generalization treated by anterior thalamic nucleus (AN) DBS to evaluate the efficacy and potential future applications of this approach as a standard method for palliative seizure control.

Methods

Six patients affected by drug-resistant complex partial seizures underwent AN DBS from March 2007 to February 2011. The preoperative tests consisted of electroencephalography (EEG), video EEG, morphologic and functional magnetic resonance imaging (MRI), non-acute positron emission tomography (PET), neuropsychological evaluation, Liverpool seizure scale, and Quality Of Life In Epilepsy (QOLIE). These tests and a seizure diary were also administered during a follow-up of at least 3 years.

Results

The improvement in terms of decrease of seizures was more than 50 % in patients affected by complex partial seizures strictly related to limbic system origin. The amelioration was unsatisfactory for patients having anatomical lesions outside the limbic structures with evidence of late diffusion in limbic areas. One patient died 40 days after surgery for reasons not concerned with DBS.

Conclusions

Although the limited number of enrolled patients limits the reliability of data, the results are in accordance with those found in the recent literature and deserve to be considered for further studies regarding real efficacy, indications, stimulation parameters, side effects, and complications.

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Conflicts of interest

None.

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Authors and Affiliations

  1. Department of Neurosurgery, San Bortolo Hospital, Viale Rodolfi, 37-36100, Vicenza, Italy

    Massimo Piacentino & Giacomo Beggio

  2. Department of Neurology, San Bortolo Hospital, Vicenza, Italy

    Christine Durisotti, Pier Gaetano Garofalo & Federica Ranzato

  3. IRCS La Nostra Famiglia, Conegliano, Italy

    Paolo Bonanni & Anna Volzone

Authors
  1. Massimo Piacentino
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  2. Christine Durisotti
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  3. Pier Gaetano Garofalo
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  4. Paolo Bonanni
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  5. Anna Volzone
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  6. Federica Ranzato
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  7. Giacomo Beggio
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Corresponding author

Correspondence to Massimo Piacentino.

Additional information

Comment

Deep brain stimulation becomes a surgical option in a growing number of highly variable indications. In the present study, the authors report their results of a retrospective outcome evaluation in six patients with drug-resistant complex partial seizures who were treated with deep brain stimulation (DBS). The authors concluded that DBS of the anterior thalamic nucleus might be an option in epileptic patients without a clear anatomical lesion and with a primitive involvement of the limbic system. Although the number of patients is very small and the findings have to be interpreted very carefully, the idea is sound. Since DBS is a safe and reversible technique, further studies to evaluate more closely the potential of this option in drug-resistant complex partial seizures are needed before the potential of DBS for this indication can be evaluated.

Joachim Oertel

Mainz, Germany

This article is a further confirmation of the efficacy of DBS/VA for drug-resistant epilepsy. Among these 6 patients reported those with temporal/limbic related epilepsy had a better outcome than the extra-limbic, 50 vs. 40 % seizure frequency improvement. Still these figures are still better than VNS therapy for drug-resistant epilepsy.

Still an improvement of 50 % of the seizures frequency needs to be considered palliation; most of patients responding to DBS/VA will be at best Engel III. The objective of resective surgery is seizure freedom with responder being Engel I or II.

The other factors to consider is the different response to DBS/VA in temporal and extra-temporal epilepsy; possibly the data suggest that DBS/VA is best suited for temporal/limbic epilepsy and CM for extra temporal and generalized epilepsy.

Jibril Osman Farah

Liverpool, UK

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Piacentino, M., Durisotti, C., Garofalo, P.G. et al. Anterior thalamic nucleus deep brain Stimulation (DBS) for drug-resistant complex partial seizures (CPS) with or without generalization: long-term evaluation and predictive outcome. Acta Neurochir 157, 1525–1532 (2015). https://doi.org/10.1007/s00701-015-2498-1

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  • DOI: https://doi.org/10.1007/s00701-015-2498-1

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