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Deep Brain Stimulation in Epilepsy: A Role for Modulation of the Mammillothalamic Tract in Seizure Control?
Neurosurgery ( IF 4.8 ) Pub Date : 2020-05-18 , DOI: 10.1093/neuros/nyaa141
Frédéric L W V J Schaper 1, 2, 3 , Birgit R Plantinga 2, 3 , Albert J Colon 4, 5 , G Louis Wagner 4, 5 , Paul Boon 4, 5, 6 , Nadia Blom 2, 3 , Erik D Gommer 7 , Govert Hoogland 2, 3, 5 , Linda Ackermans 2 , Rob P W Rouhl 1, 3, 5 , Yasin Temel 2, 3
Affiliation  

BACKGROUND Deep brain stimulation of the anterior nucleus of the thalamus (ANT-DBS) can improve seizure control for patients with drug-resistant epilepsy (DRE). Yet, one cannot overlook the high discrepancy in efficacy among patients, possibly resulting from differences in stimulation site. OBJECTIVE To test the hypothesis that stimulation at the junction of the ANT and mammillothalamic tract (ANT-MTT junction) increases seizure control. METHODS The relationship between seizure control and the location of the active contacts to the ANT-MTT junction was investigated in 20 patients treated with ANT-DBS for DRE. Coordinates and Euclidean distance of the active contacts relative to the ANT-MTT junction were calculated and related to seizure control. Stimulation sites were mapped by modelling the volume of tissue activation (VTA) and generating stimulation heat maps. RESULTS After 1 yr of stimulation, patients had a median 46% reduction in total seizure frequency, 50% were responders, and 20% of patients were seizure-free. The Euclidean distance of the active contacts to the ANT-MTT junction correlates to change in seizure frequency (r2 = 0.24, P = .01) and is ∼30% smaller (P = .015) in responders than in non-responders. VTA models and stimulation heat maps indicate a hot-spot at the ANT-MTT junction for responders, whereas non-responders had no evident hot-spot. CONCLUSION Stimulation at the ANT-MTT junction correlates to increased seizure control. Our findings suggest a relationship between the stimulation site and therapy response in ANT-DBS for epilepsy with a potential role for the MTT. DBS directed at white matter merits further exploration for the treatment of epilepsy.

中文翻译:

癫痫中的深部脑刺激:调节乳突丘脑束在癫痫发作控制中的作用?

背景 丘脑前核 (ANT-DBS) 的深部脑刺激可以改善耐药性癫痫 (DRE) 患者的癫痫发作控制。然而,人们不能忽视患者之间疗效的巨大差异,这可能是由于刺激部位的差异造成的。目的 检验在 ANT 和乳突丘脑束的交界处(ANT-MTT 交界处)进行刺激可以提高癫痫发作控制的假设。方法 在 20 名接受 ANT-DBS 治疗的 DRE 患者中,研究了癫痫发作控制与主动接触到 ANT-MTT 连接点的位置之间的关系。计算了活动触点相对于 ANT-MTT 连接点的坐标和欧几里德距离,并与癫痫控制有关。通过对组织激活体积 (VTA) 进行建模并生成刺激热图来绘制刺激部位。结果 刺激 1 年后,患者的总癫痫发作频率中位数降低 46%,50% 有反应,20% 的患者无癫痫发作。主动触点与 ANT-MTT 连接点的欧几里德距离与癫痫发作频率的变化相关 (r2 = 0.24, P = .01),并且响应者比非响应者小 30% (P = .015)。VTA 模型和刺激热图表明响应者在 ANT-MTT 连接处有一个热点,而无响应者没有明显的热点。结论 ANT-MTT 连接处的刺激与癫痫发作控制的增加相关。我们的研究结果表明 ANT-DBS 癫痫的刺激部位和治疗反应之间存在关系,MTT 具有潜在作用。
更新日期:2020-05-18
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