Responsive neurostimulation targeting the anterior nucleus of the thalamus in 3 patients with treatment-resistant multifocal epilepsy.

Electrical stimulation in the anterior nucleus of the thalamus (ANT) has previously been found to be efficacious for reducing seizure frequency in patients with epilepsy. Bilateral deep brain stimulation (DBS) of the ANT is an open-loop system that can be used in the management of treatment-resistant epilepsy. In contrast, the responsive neurostimulation (RNS) system is a closed-loop device that delivers treatment in response to prespecified electrocorticographic triggers. The efficacy and safety of RNS targeting the ANT is unknown. We describe 3 patients with treatment-resistant multifocal epilepsy who were implanted with an RNS system, which included unilateral stimulation of the ANT. After >33 months of follow-up, there were no adverse effects on mood, memory or behavior. Two patients had ≥50% reduction in disabling seizures and one patient had a 50% reduction compared to pretreatment baseline. Although reduction in seizure frequency has been modest to date, these findings support responsive neurostimulation of the ANT as feasible, safe, and well-tolerated. Further studies are needed to determine optimal stimulation parameters.

Déclaration de conflit d'intérêts

Dr. Christopher Elder reports no disclosures. Dr. Daniel Friedman receives support to NYU from the Epilepsy Study Consortium and consulting fees from Penumbra, Inc. He has served on advisory boards for GW Pharmaceuticals and Supernus. He receives research support from the National Institutes of Health (NIH), the Epilepsy Foundation, the Centers for Disease Control and Prevention (CDC), Adamas Pharmaceuticals, Empatica, NeuroPace, Inc, and UCB, Inc. He has received honoraria for education materials from NeuroPace, Inc., travel reimbursement from Medtronic, and he holds equity in Neuroview Technologies. Dr. Werner Doyle holds equity in Neuroview Technologies. Dr. Orrin Devinsky receives funding from National Institute of Neurological Disorders and Stroke (NINDS), National Institute of Mental Health (NIMH), Multidisciplinary University Research Initiatives (MURI), and the CDC. He has equity interest in Empatica, Tevard, Receptor Life Sciences, Privateer Holdings, and Engage Therapeutics. Dr. Patricia Dugan receives research support from the NIH and NeuroPace, Inc. She has received honoraria for educational materials from NeuroPace, Inc. and travel reimbursement from Medtronic and NeuroPace, Inc. We confirm that the authors have read the Journal's position on issues involved in ethical publication and affirm that this report is consistent with those guidelines.