Kim Seonjeong, Jung Semina, Lee Seunghoon, Joo Eun Yeon, Seo Dae-Won, Shon Young-Min
Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Epilepsia Open. 2025 Jul 18. doi: 10.1002/epi4.70107.
Deep brain stimulation (DBS) of the anterior thalamic nucleus (ATN) and hippocampus is an emerging therapy for drug-resistant epilepsy (DRE) when resective surgery is not feasible. We aimed to evaluate the long-term cognitive outcomes of these two DBS targets, hypothesizing that both interventions preserve cognitive function.
We conducted a retrospective analysis of DRE patients who underwent ATN-DBS (n = 12) or hippocampal DBS (n = 10) and completed comprehensive neuropsychological testing before surgery and after ≥18 months of stimulation. Testing assessed general cognition, intellectual function, memory, language, and executive function. Changes in performance (post- minus pre-DBS) were analyzed within each group and between groups, with appropriate correction for multiple comparisons.
At median follow-ups of 44.33 months (ATN-DBS) and 28.60 months (Hip-DBS), both groups achieved comparable seizure reductions, particularly for disabling seizures (ATN-DBS: 73.05%; Hip-DBS: 76.76%). No significant cognitive decline was observed in either group across any domain. After FDR correction, no cognitive measure showed significant change (p > 0.05 for all). Unadjusted comparisons revealed modest improvement trends in visuospatial reasoning with ATN-DBS (Perceptual Reasoning Index, p = 0.047 uncorrected) and semantic verbal fluency with hippocampal DBS (p = 0.041 uncorrected), but these did not remain significant after correction. Between-group comparisons identified no significant cognitive differences.
ATN and hippocampal stimulation demonstrated comparable efficacy for seizure control while maintaining cognitive stability over long-term follow-up. Despite targeting key structures in memory and cognitive networks, neither approach produced measurable cognitive deterioration. These findings provide critical reassurance regarding the cognitive safety of DBS in epilepsy and suggest that target selection can prioritize optimizing seizure control without compromising cognitive function.
This study compared cognitive outcomes in patients with difficult-to-treat epilepsy who received deep brain stimulation (DBS) in one of two brain regions: the anterior thalamic nucleus or the hippocampus. Both treatments effectively reduced seizures by over 70%. Importantly, after 2-4 years of continuous stimulation, neither treatment caused any decline in thinking abilities such as memory, language, nor problem-solving - despite targeting brain regions critical for these functions. This provides reassurance that DBS represents a cognitively safe option for epilepsy patients who cannot undergo traditional surgery.
当切除性手术不可行时，丘脑前核（ATN）和海马体的深部脑刺激（DBS）是一种新兴的耐药性癫痫（DRE）治疗方法。我们旨在评估这两个DBS靶点的长期认知结果，假设两种干预措施均能保留认知功能。
我们对接受ATN-DBS（n = 12）或海马体DBS（n = 10）的DRE患者进行了回顾性分析，这些患者在手术前和刺激≥18个月后完成了全面的神经心理学测试。测试评估了一般认知、智力功能、记忆、语言和执行功能。在每组内和组间分析了表现的变化（DBS后减去DBS前），并对多重比较进行了适当校正。
在ATN-DBS组的中位随访时间为44.33个月，海马体DBS组为28.60个月时，两组的癫痫发作减少程度相当，尤其是致残性发作（ATN-DBS组：73.05%；海马体DBS组：76.76%）。两组在任何领域均未观察到明显的认知下降。在进行错误发现率（FDR）校正后，没有认知指标显示出显著变化（所有p>0.05）。未经校正的比较显示，ATN-DBS组在视觉空间推理方面有适度改善趋势（知觉推理指数，未校正p = 0.047），海马体DBS组在语义言语流畅性方面有适度改善趋势（未校正p = 0.041），但校正后这些均不再显著。组间比较未发现显著的认知差异。
在长期随访中，ATN和海马体刺激在控制癫痫发作方面显示出相当的疗效，同时保持了认知稳定性。尽管针对记忆和认知网络中的关键结构，但两种方法均未导致可测量的认知恶化。这些发现为DBS治疗癫痫的认知安全性提供了关键的保证，并表明靶点选择可以优先优化癫痫控制而不损害认知功能。
本研究比较了在两个脑区之一接受深部脑刺激（DBS）的难治性癫痫患者的认知结果：丘脑前核或海马体。两种治疗方法均有效减少了70%以上的癫痫发作。重要的是，在持续刺激2至4年后，两种治疗方法均未导致记忆、语言或解决问题等思维能力下降——尽管针对的是对这些功能至关重要的脑区。这为无法接受传统手术的癫痫患者提供了保证，即DBS是一种认知安全的选择。
