Deep Brain Stimulation of the Centromedian Nucleus of the Thalamus for Lennox-Gastaut Syndrome: A Systematic Review and Individual Patient Data Analysis.


Journal

Neurosurgery
ISSN: 1524-4040
Titre abrégé: Neurosurgery
Pays: United States
ID NLM: 7802914

Informations de publication

Date de publication:
01 04 2023
Historique:
received: 04 07 2022
accepted: 29 09 2022
pubmed: 27 1 2023
medline: 21 3 2023
entrez: 26 1 2023
Statut: ppublish

Résumé

Lennox-Gastaut syndrome (LGS) is a severe childhood-onset pharmacoresistant epilepsy. Deep brain stimulation (DBS) of the centromedian nucleus of the thalamus (CMN) has been utilized. To conduct a systematic review and individual patient data (IPD) analysis to characterize outcomes of DBS of CMN in LGS. PubMed, Embase, and Scopus were searched per Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Articles were screened by title/abstract then full text. Included articles were reviewed for bibliographic, demographic, and outcome data. IPD were extracted from studies providing IPD for all patients. Of 72 resultant articles, 10 studies (114 patients) were included. Six of 7 studies reporting the outcome of ≥50% seizure reduction indicated that ≥50% of patients achieved this, with improved functional ability. Seizure freedom rate was generally <10%. Six studies with 47 patients provided IPD. The mean ages at epilepsy onset and CMN DBS were 3.9 ± 4.5 years and 17.4 ± 8.8 years, respectively. Nineteen of 41 (46.3%) patients had positive MRI findings. Seizure types included atypical absence in 39 (83.0%) patients, generalized tonic-clonic in 32 (68.1%), tonic in 22 (46.8%), and atonic in 20 (42.6%). Thirty-eight (80.9%) patients experienced ≥50% reduction in seizure frequency, and only 3 (6.4%) experienced seizure freedom. The mean seizure reduction was 62.9% ± 31.2% overall. Quality of life improved in 30/34 (88.2%) and was unchanged in the remainder (11.8%). The complication rate was 2/41 (4.9%). The mean length of follow-up was 19.8 ± 26.1 months (IQR: 4-18 months). Limited data indicate that DBS of the CMN may be effective and safe for people with LGS.

Sections du résumé

BACKGROUND
Lennox-Gastaut syndrome (LGS) is a severe childhood-onset pharmacoresistant epilepsy. Deep brain stimulation (DBS) of the centromedian nucleus of the thalamus (CMN) has been utilized.
OBJECTIVE
To conduct a systematic review and individual patient data (IPD) analysis to characterize outcomes of DBS of CMN in LGS.
METHODS
PubMed, Embase, and Scopus were searched per Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Articles were screened by title/abstract then full text. Included articles were reviewed for bibliographic, demographic, and outcome data. IPD were extracted from studies providing IPD for all patients.
RESULTS
Of 72 resultant articles, 10 studies (114 patients) were included. Six of 7 studies reporting the outcome of ≥50% seizure reduction indicated that ≥50% of patients achieved this, with improved functional ability. Seizure freedom rate was generally <10%. Six studies with 47 patients provided IPD. The mean ages at epilepsy onset and CMN DBS were 3.9 ± 4.5 years and 17.4 ± 8.8 years, respectively. Nineteen of 41 (46.3%) patients had positive MRI findings. Seizure types included atypical absence in 39 (83.0%) patients, generalized tonic-clonic in 32 (68.1%), tonic in 22 (46.8%), and atonic in 20 (42.6%). Thirty-eight (80.9%) patients experienced ≥50% reduction in seizure frequency, and only 3 (6.4%) experienced seizure freedom. The mean seizure reduction was 62.9% ± 31.2% overall. Quality of life improved in 30/34 (88.2%) and was unchanged in the remainder (11.8%). The complication rate was 2/41 (4.9%). The mean length of follow-up was 19.8 ± 26.1 months (IQR: 4-18 months).
CONCLUSION
Limited data indicate that DBS of the CMN may be effective and safe for people with LGS.

Identifiants

pubmed: 36700706
doi: 10.1227/neu.0000000000002280
pii: 00006123-202304000-00007
doi:

Types de publication

Systematic Review Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

703-715

Informations de copyright

Copyright © Congress of Neurological Surgeons 2022. All rights reserved.

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Auteurs

Nathan A Shlobin (NA)

Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.

Katherine Hofmann (K)

Deparment of Neurosurgery, Children's National Hospital, Washington, District of Columbia, USA.

Nathan T Cohen (NT)

Department of Neurology, Children's National Hospital, Washington, District of Columbia, USA.

Mohamad Z Koubeissi (MZ)

Department of Neurology, The George Washington University, Washington, District of Columbia, USA.

William D Gaillard (WD)

Department of Neurology, Children's National Hospital, Washington, District of Columbia, USA.

Chima O Oluigbo (CO)

Deparment of Neurosurgery, Children's National Hospital, Washington, District of Columbia, USA.

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