Effectiveness of Deep Brain Stimulation (DBS) in the Anterior Thalamic Nucleus (ATN) for Drug-Resistant Epilepsy: A Comprehensive Literature Review
Abstract
Epilepsy, a chronic neurological disorder characterized by recurrent seizures, significantly impacts the lives of millions worldwide. While antiepileptic drugs have become the standard of care for seizure control, a substantial portion of epilepsy patients, estimated at approximately one-third, continues to experience seizures despite trying multiple medications. Consequently, there is a pressing need to explore alternative and more effective treatment options. This study was conducted to review more deeply Deep Brain Stimulation (DBS) has emerged as a promising intervention for individuals with drug-resistant epilepsy. DBS entails the implantation of small electrodes into specific brain regions to provide controlled electrical stimulation, aiming to modulate abnormal neural activity associated with seizures. Among the targeted brain regions, the Anterior Thalamic Nucleus (ATN) has garnered substantial attention due to its potential to reduce seizure frequency in individuals for whom conventional therapies have proven inadequate. A literature search was conducted from journal articles using databases in the form of Pubmed, Medline, Google Scholar, Proquest, Embase, SAGE, and Web of Science. The search strategy involved using a set of keywords and their synonyms without any publication date restrictions. In this comprehensive review, the effectiveness of DBS in the ATN for drug-resistant epilepsy is critically examined. Notably, recent clinical trials have shown significant promise. For instance, the SANTE (Stimulation of Anterior Nucleus of Thalamus for Epilepsy) study demonstrated that, after three months, 110 drug-resistant epilepsy patients receiving DBS in the ATN experienced a remarkable 40% reduction in seizure frequency. Long-term follow-up revealed progressive improvements, with a subsequent 69% decrease in seizure frequency over five years. There is potential adverse events associated with DBS, including bledding, infections, paresthesia, moving disorder and psychiatric disorder. DBS is highly effective in reducing seizure frequency, controlling seizures, and improving the patient’s quality of life. DBS can also serve as a treatment option for various other neurological disorders. In the future it is expected to become more effective with advances in neuroscience, particularly neurointerventions, which allow more precise anatomical targeting. Monitoring possible side effects caused by DBS is critical to optimizing patient outcomes. In conclusion, this review underscores the potential of DBS in the ATN as an effective therapy for drug-resistant epilepsy. While significant progress has been made, further research is needed to refine treatment parameters, enhance patient selection, and evaluate long-term outcomes. DBS represents a beacon of hope for individuals whose lives are profoundly affected by drug-resistant epilepsy, offering the prospect of improved seizure control and enhanced quality of life.
References
Li, M. C., & Cook, M. J. (2017). Deep brain stimulation for drug‐resistant epilepsy. Epilepsia, 59(2), 273–290. https://doi.org/10.1111/epi.13964
Xu, X., Ling, Z. P., Mao, Z. Q., Pan, L. S., Cui, Z., & Yu, X. (2015). Clinical study on treatment of drug-resistant epilepsy with deep brain stimulation in bilateral anterior thalamic nuclei. Chinese Journal of Contemporary Neurology and Neurosurgery, 15(9), 716–721. https://doi.org/10.3969/j.issn.1672-6731.2015.09.0073.
Deep Brain stimulation. Neurosurgical Associates of San Antonio. (2019, December 13). https://neurosurgerysa.com/deep-brain-stimulation.
Pycroft, L., Stein, J., & Aziz, T. (2018). Deep Brain Stimulation: An overview of history, methods, and future developments. Brain and Neuroscience Advances, 2, 239821281881601. https://doi.org/10.1177/2398212818816017.
Zangiabadi, N., Ladino, L. D., Sina, F., Orozco-Hernández, J. P., Carter, A., & Téllez-Zenteno, J. F. (2019). Deep brain stimulation and drug-resistant epilepsy: A review of the literature. Frontiers in Neurology, 10. https://doi.org/10.3389/fneur.2019.00601.
Bouwens van der Vlis, T. A., Schijns, O. E., Schaper, F. L., Hoogland, G., Kubben, P., Wagner, L., Rouhl, R., Temel, Y., & Ackermans, L. (2018). Deep brain stimulation of the anterior nucleus of the thalamus for drug-resistant epilepsy. Neurosurgical Review, 42(2), 287–296. https://doi.org/10.1007/s10143-017-0941-x
Salanova, V., Witt, T., Worth, R., Henry, T. R., Gross, R. E., Nazzaro, J. M., Labar, D., Sperling, M. R., Sharan, A., Sandok, E., Handforth, A., Stern, J. M., Chung, S., Henderson, J. M., French, J., Baltuch, G., Rosenfeld, W. E., Garcia, P., Barbaro, N. M., … Bergen, D. (2015). Long-term efficacy and safety of thalamic stimulation for drug-resistant partial epilepsy. Neurology, 84(10), 1017–1025. https://doi.org/10.1212/wnl.0000000000001334
Tellez-Zenteno, J. F., McLachlan, R. S., Parrent, A., Kubu, C. S., & Wiebe, S. (2006). Hippocampal electrical stimulation in Mesial Temporal Lobe epilepsy. Neurology, 66(10), 1490–1494. https://doi.org/10.1212/01.wnl.0000209300.49308.8f
Fisher, R. S., Uematsu, S., Krauss, G. L., Cysyk, B. J., McPherson, R., Lesser, R. P., Gordon, B., Schwerdt, P., & Rise, M. (1992). Placebo‐controlled pilot study of Centromedian thalamic stimulation in treatment of intractable seizures. Epilepsia, 33(5), 841–851. https://doi.org/10.1111/j.1528-1157.1992.tb02192.x
Velasco, F., Velasco, M., Jiménez, F., Velasco, A. L., Brito, F., Rise, M., & Carrillo-Ruiz, J. D. (2000). Predictors in the treatment of difficult-to-control seizures by electrical stimulation of the centromedian thalamic nucleus. Neurosurgery, 47(2), 295–305. https://doi.org/10.1097/00006123-200008000-00007
Upton, A. R. M., Amin, I., Garnett, S., Springman, M., Nahmias, C., & Cooper, I. S. (1987). Evoked metabolic responses in the Limbicstriate system produced by stimulation of anterior thalamic nucleus in man. Pacing and Clinical Electrophysiology, 10(1), 217–225. https://doi.org/10.1111/j.1540-8159.1987.tb05952.x
Hodaie, M., Wennberg, R. A., Dostrovsky, J. O., & Lozano, A. M. (2002). Chronic anterior thalamus stimulation for intractable epilepsy. Epilepsia, 43(6), 603–608. https://doi.org/10.1046/j.1528-1157.2002.26001.x
Kerrigan, J. F., Litt, B., Fisher, R. S., Cranstoun, S., French, J. A., Blum, D. E., Dichter, M., Shetter, A., Baltuch, G., Jaggi, J., Krone, S., Brodie, M., Rise, M., & Graves, N. (2004). Electrical stimulation of the anterior nucleus of the thalamus for the treatment of intractable epilepsy. Epilepsia, 45(4), 346–354. https://doi.org/10.1111/j.0013-9580.2004.01304.x
Lee, K. J., Jang, K. S., & Shon, Y. M. (2006). Chronic deep brain stimulation of subthalamic and anterior thalamic nuclei for controlling refractory partial epilepsy. Advances in Functional and Reparative Neurosurgery, 87–91. https://doi.org/10.1007/978-3-211-35205-2_17
Andrade, D. M., Zumsteg, D., Hamani, C., Hodaie, M., Sarkissian, S., Lozano, A. M., & Wennberg, R. A. (2006). Long-term follow-up of patients with thalamic deep brain stimulation for epilepsy. Neurology, 66(10), 1571–1573. https://doi.org/10.1212/01.wnl.0000206364.19772.39
Lim, S., Lee, S., Tsai, Y., Chen, I., Tu, P., Chen, J., Chang, H., Su, Y., & Wu, T. (2007). Electrical stimulation of the anterior nucleus of the thalamus for intractable epilepsy: A long‐term follow‐up study. Epilepsia, 48(2), 342–347. https://doi.org/10.1111/j.1528-1167.2006.00898.x
Osorio, I., Overman, J., Giftakis, J., & Wilkinson, S. B. (2007). High frequency thalamic stimulation for inoperable mesial temporal epilepsy. Epilepsia, 48(8), 1561–1571. https://doi.org/10.1111/j.1528-1167.2007.01044.x
Fisher, R., Salanova, V., Witt, T., Worth, R., Henry, T., Gross, R., Oommen, K., Osorio, I., Nazzaro, J., Labar, D., Kaplitt, M., Sperling, M., Sandok, E., Neal, J., Handforth, A., Stern, J., DeSalles, A., Chung, S., Shetter, A., … Graves, N. (2010). Electrical stimulation of the anterior nucleus of thalamus for treatment of refractory epilepsy. Epilepsia, 51(5), 899–908. https://doi.org/10.1111/j.1528-1167.2010.02536.x
Lee, Kyung Jin, Shon, Y. M., & Cho, C. B. (2012). Long-term outcome of anterior thalamic nucleus stimulation for intractable epilepsy. Stereotactic and Functional Neurosurgery, 90(6), 379–385. https://doi.org/10.1159/000339991
Piacentino, M., Durisotti, C., Garofalo, P. G., Bonanni, P., Volzone, A., Ranzato, F., & Beggio, G. (2015). Anterior thalamic nucleus deep brain stimulation (DBS) for drug-resistant complex partial seizures (CPS) with or without generalization: Long-term evaluation and predictive outcome. Acta Neurochirurgica, 157(9), 1525–1532. https://doi.org/10.1007/s00701-015-2498-1
Fenoy, A. J., & Simpson, R. K. (2014). Risks of common complications in deep brain stimulation surgery: Management and avoidance. Journal of Neurosurgery, 120(1), 132–139. https://doi.org/10.3171/2013.10.jns131225
Mar-Barrutia, L., Real, E., Segalás, C., Bertolín, S., Menchón, J. M., & Alonso, P. (2021). Deep brain stimulation for obsessive-compulsive disorder: A systematic review of worldwide experience after 20 years. World Journal of Psychiatry, 11(9), 659–680. https://doi.org/10.5498/wjp.v11.i9.659
Hariz, M., & Blomstedt, P. (2022). Deep brain stimulation for parkinson’s disease. Journal of Internal Medicine, 292(5), 764–778. https://doi.org/10.1111/joim.13541
Krishna, V., King, N. K., Sammartino, F., Strauss, I., Andrade, D. M., Wennberg, R. A., & Lozano, A. M. (2016a). Anterior nucleus deep brain stimulation for refractory epilepsy. Neurosurgery, 78(6), 802–811. https://doi.org/10.1227/neu.0000000000001197
Doležalová, I., Kunst, J., Kojan, M., Chrastina, J., Baláž, M., & Brázdil, M. (2019). Anterior thalamic deep brain stimulation in epilepsy and persistent psychiatric side effects following discontinuation. Epilepsy Behavior Reports, 12, 100344. https://doi.org/10.1016/j.ebr.2019.100344
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