OBJECTIVE The aim of the study was to determine if corticothalamic responsive stimulation targeting the centromedian nucleus of the thalamus (CMT) is a potential treatment for neocortical epilepsies with regional onsets. METHODS We assessed efficacy and safety of CMT and neocortical responsive stimulation, detection, and stimulation programming, methods for implantation, and location and patterns of electrographic seizure onset and spread in 7 patients with medically intractable focal seizures with a regional neocortical onset. RESULTS The median follow-up duration was 17 months (average: 17 months, range: 8-28 months). The median % reduction in disabling seizures (excludes auras) in the 7 patients was 88% (mean: 80%, range: 55-100%). The median % reduction in all seizure types (disabling + auras) was 73% (mean: 67%, range: 15-94%). There were no adverse events related to implantation of the responsive neurostimulator and leads or related to the delivery of responsive stimulation. Stimulation-related contralateral paresthesias were addressed by adjusting stimulation parameters in the clinic during stimulation testing. Electrographic seizures were detected in the CMT and neocortex in all seven patients. Four patients had simultaneous or near simultaneous seizure onsets in the neocortex and CMT and three had onsets in the neocortex with spread to the CMT. CONCLUSION In this small series of patients with medically intractable focal seizures and regional neocortical onset, responsive neurostimulation to the neocortex and CMT improved seizure control and was well tolerated. SIGNIFICANCE Responsive corticothalamic neurostimulation of the CMT and neocortex is a potential treatment for patients with regional neocortical epilepsies.

中文翻译：

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中心正中核的脑反应性皮质丘脑刺激治疗区域性新皮质癫痫

目的 本研究的目的是确定针对丘脑中心正中核 (CMT) 的皮质丘脑反应性刺激是否是局部发作的新皮质癫痫的潜在治疗方法。方法 我们评估了 CMT 和新皮质反应性刺激、检测和刺激程序、植入方法以及电图癫痫发作和扩散的位置和模式的有效性和安全性，这些患者在 7 名具有区域性新皮质发作的医学上顽固性局灶性癫痫发作的患者中。结果 中位随访时间为 17 个月（平均：17 个月，范围：8-28 个月）。7 名患者的致残性癫痫发作（不包括先兆）的中位数降低百分比为 88%（平均值：80%，范围：55-100%）。所有癫痫类型（致残+先兆）的中位数减少百分比为 73%（平均值：67%，范围：15-94%）。没有与植入响应性神经刺激器和导线相关或与响应性刺激的传递相关的不良事件。通过在刺激测试期间调整临床中的刺激参数来解决刺激相关的对侧感觉异常。在所有 7 名患者的 CMT 和新皮质中都检测到了电图癫痫发作。4 名患者在新皮质和 CMT 中同时或几乎同时发生癫痫发作，3 名患者在新皮质中发作并扩散到 CMT。结论 在这个小系列的医学上难治性局灶性癫痫发作和局部新皮质发作的患者中，对新皮质和 CMT 的反应性神经刺激改善了癫痫发作控制，并且耐受性良好。