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Outcome based definition of the anterior thalamic deep brain stimulation target in refractory epilepsy

2015; Elsevier BV; Volume: 9; Issue: 2 Linguagem: Inglês

10.1016/j.brs.2015.09.014

1935-861X

K. Lehtimäki, Timo Möttönen, Kaija Järventausta, Jani Katisko, Timo Tähtinen, Joonas Haapasalo, Tero Niskakangas, Tommi Kiekara, Juha Öhman, Jukka Peltola,

Neuroscience and Neuropharmacology Research

BackgroundDeep brain stimulation of the anterior nucleus of the thalamus (ANT) is an emerging therapy for refractory focal epilepsy. However, the most optimal target for stimulation has not been unambiguously described.ObjectiveIn the present study, we investigated the correlation between the stimulation site and outcome in order to define the optimal target for deep brain stimulation in refractory epilepsy.MethodsThe locations of 62 contacts used in 30 treatment attempts in 15 prospectively followed patients during a 5 year period were assessed. Treatment attempts were classified into responding and non-responding trials using seizure reduction and side effect profile as criteria. The locations of active contacts were calculated with respect to mid-commissural point and visible borders of ANT in 3T MRI (ANT-normalized coordinate system) aiming to minimize the confounding effect of individual variation in the location and size of the ANT.ResultsContacts in successful treatment trials were located significantly more anterior and superior both in AC–PC and ANT-normalized coordinate systems. Favourable outcome was observed at 3T MRI based location of ANT but not at location predicted by Schaltenbrandt atlas sagittal data. Contacts used in successful trials were at anterior aspect of the ANT complex evidenced by the ANT-normalized coordinate system.ConclusionThe anti-epileptic effect of anterior thalamic DBS may be dependent on stimulation site especially in the anterior to posterior axis. Extensive anatomical variation confounds severely the targeting of ANT. Therefore, direct visualization of the desired target for stimulation is essential for favourable outcome in refractory epilepsy.