Chandran Arjun Suresh, Joshi Stuti, Suresh Surya, Savarraj Jude, Snyder Kathryn, Vasconcellos Fernando De Nigris, Vakilna Yash S, Modiano Yosefa A, Pati Sandipan, Tandon Nitin
Texas Comprehensive Epilepsy Program, Department of Neurosurgery, University of Texas Health Science Center at Houston, Houston, Texas, USA.
Texas Comprehensive Epilepsy Program, Department of Neurology, University of Texas Health Science Center at Houston, Houston, Texas, USA.
Epilepsia. 2025 Apr;66(4):1059-1070. doi: 10.1111/epi.18244. Epub 2025 Jan 11.
The pulvinar nucleus of the thalamus has extensive cortical connections with the temporal, parietal, and occipital lobes. Deep brain stimulation (DBS) targeting the pulvinar nucleus, therefore, carries the potential for therapeutic benefit in patients with drug-resistant posterior quadrant epilepsy (PQE) and neocortical temporal lobe epilepsy (TLE). Here, we present a single-center experience of patients managed via bilateral DBS of the pulvinar nucleus.
A single-institution retrospective review of five patients who underwent bilateral pulvinar DBS for drug-resistant TLE or PQE was performed. Stimulation parameters were adjusted monthly as needed, and side effects were monitored. The primary outcome was the percentage reduction in patient-reported seizure frequency in comparison to the preimplant baseline. The location of the active electrode contacts in relation to pulvinar thalami that produced the best seizure outcome was identified. Chronic sensing of the pulvinar local field potentials (LFPs) and circadian pattern of modulation of the LFP amplitudes were analyzed.
Four patients (80%) experienced a >70% reduction in seizure frequency, whereas one patient had >50% reduction in seizure. Mean seizure reduction was 79% at a median follow-up of 13 months (range = 9-21 months). No significant side effects were noted. Of all the pulvinar subnuclei, stimulation of the medial pulvinar nucleus (MPN) produced the best seizure outcome in all patients except for two, in whom active contacts in the MPN but also in more lateral and inferior locations resulted in the most significant reduction in seizures. Chronic timeline data identified changes in LFP amplitude associated with stimulation and seizure occurrences.
In this first ever report on a series of patients undergoing bilateral pulvinar DBS for drug-resistant epilepsy, we demonstrate that stimulation of the pulvinar and in particular the MPN is a safe and viable option for patients with nonlesional PQE or TLE. The optimal target for stimulation and relative merits of open versus closed loop stimulation should be delineated in future studies.
丘脑枕核与颞叶、顶叶和枕叶有广泛的皮质连接。因此，针对枕核的深部脑刺激（DBS）对耐药性后象限癫痫（PQE）和新皮质颞叶癫痫（TLE）患者具有潜在的治疗益处。在此，我们介绍通过双侧枕核DBS治疗患者的单中心经验。
对5例因耐药性TLE或PQE接受双侧枕核DBS的患者进行单机构回顾性研究。根据需要每月调整刺激参数，并监测副作用。主要结局是与植入前基线相比患者报告的癫痫发作频率降低的百分比。确定产生最佳癫痫发作结局的有源电极触点相对于丘脑枕核的位置。分析了枕核局部场电位（LFP）的长期监测以及LFP振幅调制的昼夜模式。
4例患者（80%）癫痫发作频率降低>70%，而1例患者癫痫发作频率降低>50%。中位随访13个月（范围=9-21个月）时，平均癫痫发作减少率为79%。未观察到明显副作用。在所有枕核亚核中，除2例患者外，刺激内侧枕核（MPN）在所有患者中产生了最佳癫痫发作结局，这2例患者中MPN以及更外侧和下方位置的有源触点导致癫痫发作减少最为显著。长期时间线数据确定了与刺激和癫痫发作发生相关的LFP振幅变化。
在这份关于一系列因耐药性癫痫接受双侧枕核DBS治疗患者的首次报告中，我们证明刺激枕核尤其是MPN对非损伤性PQE或TLE患者是一种安全可行的选择。未来研究应明确刺激的最佳靶点以及开环与闭环刺激的相对优点。
