Feys Odile, Pizzo Francesca, Makhalova Julia, Carron Romain, Bartolomei Fabrice
APHM, Timone Hospital, Epileptology and Cerebral Rhythmology, Marseille, France.
Aix-Marseille Université, INSERM, INS, Institut de Neurosciences des Systèmes, Marseille, France.
Front Neurol. 2025 Jun 2;16:1608715. doi: 10.3389/fneur.2025.1608715. eCollection 2025.
This review explores the role of the thalamus in focal epilepsy, focusing on insights gained from stereoelectroencephalography (SEEG). The thalamus has recently regained attention as a crucial player in seizure dynamics. Thalamic SEEG recordings can be used to assess certain aspects of the thalamus's role in human focal epilepsy, in particular the timing and dynamics of involvement of distinct thalamic nuclei during seizures and in interictal activity. Estimation of thalamic involvement in seizure propagation may be valuable before embarking on surgical resection and provide guidance for neuromodulation strategies. High thalamic epileptogenicity correlates with poorer surgical outcomes, making it a predictive biomarker. Deep brain stimulation (DBS), particularly targeting the anterior and pulvinar nuclei, has effectively reduced seizure frequency and improved consciousness during seizures. However, the effectiveness of DBS varies, emphasizing the need for individual targeting based on individual seizure dynamics. High-frequency thalamic stimulation can reduce seizure frequency and alter epileptogenic networks, offering tailored therapeutic approaches. Despite the potential added surgical risks of depth electrode implantation, thalamic SEEG significantly enhances the understanding of epileptogenic networks. It supports the development of personalized epilepsy treatments by elucidating the complex interplay between cortical and subcortical regions, paving the way for improved seizure management and neuromodulation strategies.
本综述探讨了丘脑在局灶性癫痫中的作用，重点关注从立体脑电图（SEEG）中获得的见解。丘脑最近作为癫痫发作动态中的关键参与者重新受到关注。丘脑SEEG记录可用于评估丘脑在人类局灶性癫痫中作用的某些方面，特别是在癫痫发作期间和发作间期不同丘脑核参与的时间和动态。在进行手术切除之前，估计丘脑在癫痫传播中的参与情况可能很有价值，并为神经调节策略提供指导。高丘脑致痫性与较差的手术结果相关，使其成为一种预测性生物标志物。深部脑刺激（DBS），特别是针对前核和枕核，有效地降低了癫痫发作频率并改善了发作期间的意识。然而，DBS的有效性各不相同，强调需要根据个体癫痫发作动态进行个体化靶向治疗。高频丘脑刺激可以降低癫痫发作频率并改变致痫网络，提供量身定制的治疗方法。尽管深度电极植入可能会增加手术风险，但丘脑SEEG显著增强了对致痫网络的理解。它通过阐明皮质和皮质下区域之间的复杂相互作用，支持个性化癫痫治疗的发展，为改善癫痫管理和神经调节策略铺平了道路。
