Electrical Stimulation of the Anterior Nucleus of Thalamus for Treatment of Refractory Epilepsy
Purpose: We report a multicenter, double-blind, randomized trial of bilateral stimulation of the anterior nuclei of the thalamus for localization-related epilepsy. Methods: Participants were adults with medically refractory partial seizures, including secondarily generalized seizures. Half received stimulation and half no stimulation during a 3-month blinded phase; then all received unblinded stimulation. Results: One hundred ten participants were randomized. Baseline monthly median seizure frequency was 19.5. In the last month of the blinded phase the stimulated group had a 29% greater reduction in seizures compared with the control group, as estimated by a generalized estimating equations (GEE) model (p = 0.002). Unadjusted median declines at the end of the blinded phase were 14.5% in the control group and 40.4% in the stimulated group. Complex partial and \"most severe\" seizures were significantly reduced by stimulation. By 2 years, there was a 56% median percent reduction in seizure frequency; 54% of patients had a seizure reduction of at least 50%, and 14 patients were seizure-free for at least 6 months. Five deaths occurred and none were from implantation or stimulation. No participant had symptomatic hemorrhage or brain infection. Two participants had acute, transient stimulation-associated seizures. Cognition and mood showed no group differences, but participants in the stimulated group were more likely to report depression or memory problems as adverse events. Discussion: Bilateral stimulation of the anterior nuclei of the thalamus reduces seizures. Benefit persisted for 2 years of study. Complication rates were modest. Deep brain stimulation of the anterior thalamus is useful for some people with medically refractory partial and secondarily generalized seizures.
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Fisher, Robert; Salanova, Vicenta; Witt, Thomas; Worth, Robert; Henry, Thomas; Gross, Robert; Oommen, Kalarickal; Osorio, Ivan; Nazzaro, Jules; Labar, Douglas; Kaplitt, Michael; Sperling, Michael; Sandok, Evan; Neal, John; Handforth, Adrian; Stern, John; DeSalles, Antonio; Chung, Steve; Treiman, David M.; and al., et, "Electrical Stimulation of the Anterior Nucleus of Thalamus for Treatment of Refractory Epilepsy" (2010). Neurology. 263.