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- Title
Deep Brain Stimulation for Refractory Epilepsy: Do Firing Patterns in the Anterior Nucleus of Thalamus Relate to Therapy Response?
- Authors
Schaper, Frédéric L. W. V. J.; Zhao, Yan; Wagner, Louis; Colon, Albert J.; van Kranen-Mastenbroek, Vivianne H. J. M.; Hilkman, Danny M. W.; Gommer, Erik D.; Vlooswijk, Marielle C. G.; Janssen, Markus L. F.; Ackermans, Linda; Hoogland, Govert; van Wezel, Richard; Boon, Paul A.; Heida, Tjitske C.; Rouhl, Rob P. W.; Temel, Yasin
- Abstract
Introduction: Therapy response to deep brain stimulation (DBS) of the anterior nucleus of thalamus (ANT) for medically refractory epilepsy varies highly among patients. Precise positioning of the DBS lead is potentially crucial to maximize therapeutic efficacy and minimize side effects. For a correct implantation, the ANT is anatomically located using pre-operative 3T MRI and perioperative microelectrode recordings (MERs). Recordings of neuronal firing patterns produce a 'popcorn popping' sound, which empirically differs among patients. Objective: We investigate whether firing patterns in the ANT relate to therapy response in DBS for epilepsy. Patients and Procedures: We prospectively included 10 consecutive medically refractory epilepsy patients planned for DBS surgery. Using pre-operative 3T MRI, we planned an extraventricular approach to the ANT and performed MERs along this trajectory. We compared characteristics of neuronal signals at different depths along the electrode trajectory between DBS responders and non-responders. Responders were defined as patients with a seizure frequency reduction of more than 50% at 1 year follow-up. The anatomical locations of recordings were verified using fused preoperative 3T MR-images and postoperative CT-images. Results: We found high-amplitude neuronal bursts around the target region and in the ANT. Preliminary results suggest that responders to DBS (n = 5) have higher mean firing rates and higher mean firing rates within bursts near the target region compared to non-responders (n = 5), with a clearer delineation of firing rate at target compared to surroundings. Electrode trajectories did not differ between responders and non-responders. Conclusion: Preliminary results suggest that firing patterns in the ANT relate to therapy response in DBS for patients with medically refractory epilepsy. Perioperative analysis of firing patterns using MERs may guide targeting and contribute to the prediction of therapy response in DBS for epilepsy.
- Publication
Stereotactic & Functional Neurosurgery, 2016, Vol 94, p6
- ISSN
1011-6125
- Publication type
Article
- DOI
10.1159/000448961