Targeting thalamocortical circuits for closed-loop stimulation in Lennox-Gastaut syndrome.

This paper outlines the therapeutic rationale and neurosurgical targeting technique for bilateral, closed-loop, thalamocortical stimulation in Lennox-Gastaut syndrome, a severe form of childhood-onset epilepsy. Thalamic stimulation can be an effective treatment for Lennox-Gastaut syndrome, but complete seizure control is rarely achieved. Outcomes may be improved by stimulating areas beyond the thalamus, including cortex, but the optimal targets are unknown. We aimed to identify a cortical target by synthesizing prior neuroimaging studies, and to use this knowledge to advance a dual thalamic (centromedian) and cortical (frontal) approach for closed-loop stimulation. Multi-modal brain network maps from three group-level studies of Lennox-Gastaut syndrome were averaged to define the area of peak overlap: simultaneous EEG-functional MRI of generalized paroxysmal fast activity, [

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© The Author(s) 2024. Published by Oxford University Press on behalf of the Guarantors of Brain.

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A.E.L.W., M.P.H., L.J.D., E.M.-L., F.L.W.V.J.S., L.A.H., H.S. and K.L.B. have no competing interests to report. C.R.B. has recently served as a consultant for NeuraModix and Abbott and holds intellectual property related to neuromodulation therapy. J.S.A. has received honoraria from Medtronic. R.E.G. received research support from NeuroPace, Medtronic and Boston Scientific, and consulting payments from Medtronic, Boston Scientific, Abbott Labs and Nia Therapeutics, and holds equity interest in Nia Therapeutics; the arrangements are all approved by Emory University. L.J. and M.J.M. have equity ownership with NeuroPace and are employees of NeuroPace, Inc. J.D.R. has received consulting payments from Medtronic, Corlieve and NeuroPace.