China
Africa
Explore chapters and articles related to this topic
EEG recording from the subthalamic nucleus in patients with epilepsy
Published in Hans O Lüders, Deep Brain Stimulation and Epilepsy, 2020
Dudley S Dinner, Silvia Neme, Hans O Lüders
Direct stimulation of the brain was first used in the 1970s when Cooper and his colleagues attempted to achieve control of seizures by cerebellar stimulation.7,8 This was followed by stimulation of deep brain nuclei including the centromedian thalamic nuclei,9–15 the anterior thalamus,15,16 and the caudate nucleus.17 Unfortunately all of these studies were performed in an uncontrolled fashion except for the study performed by Fisher and colleagues.9 They investigated the effect of control of seizures with stimulation of the centromedian nucleus of the thalamus in seven patients, but did not document any statistically significant effect. There are several epilepsy centers that are currently involved in trials of DBS of the thalamus or the subthalamic nucleus (STN) in the management of intractable epilepsy. At the Cleveland Clinic Foundation we are involved in a trial of high frequency stimulation (HFS) of the STN in the management of intractable epilepsy.
Thalamic neuromodulation in epilepsy: A primer for emerging circuit-based therapies
Published in Expert Review of Neurotherapeutics, 2023
Bryan Zheng, David D. Liu, Brian B Theyel, Hael Abdulrazeq, Anna R. Kimata, Peter M Lauro, Wael F. Asaad
Because classification schemes based primarily on local anatomy and histology do not capture the functional heterogeneity of individual thalamic nuclei, some modern thalamic classification systems are based on circuit topology[26]. Distinctions have been made based on (i) the characteristics of thalamocortical output – core versus matrix nuclei[27], (ii) input – first- versus higher-order nuclei[28], or (iii) both input and output[29]. For example (of [i]), the anterior nucleus of the thalamus (ANT) has been defined as a core nucleus because it provides focal projections as a node in the medial limbic circuit. The pulvinar nucleus, specifically the PuM, also possesses ‘core-like’ properties based on its distinct circuits involving the temporal lobe[24]. In contrast, matrix nuclei like the centromedian nucleus of the thalamus (CMT) are characterized by markedly more diffuse cortical projections[30]. Meanwhile, within the framework of the first- and higher-order nuclear scheme (ii): first-order nuclei receive ‘driver’ inputs from subcortical sites carrying primary sensory information (e.g. lateral geniculate nucleus [LGN] receives visual input from the retina), while higher-order nuclei (e.g. the pulvinar) receive driver inputs from cortical layer V and primarily participate in transthalamic cortico-cortical circuits[28]. This classification scheme is useful in that it highlights how the thalamus continues to be involved in information processing between areas of cortex in addition to modulating and relaying primary sensory information.
Neuromodulation - Science and Practice in Epilepsy: Vagus Nerve Stimulation, Thalamic Deep Brain Stimulation, and Responsive NeuroStimulation
Published in Expert Review of Neurotherapeutics, 2019
Matthew S. Markert, Robert S. Fisher
Space does not permit detailed discussion of other neuromodulation treatments for epilepsy, but there are notable examples worthy of mention. Examples are referenced in Table 2, and considerably more detail can be found in excellent reviews from 2017 to 2018 [4,136,137]. Developing level I evidence supports hippocampal targeting of open-loop DBS and strong trials in other deep targets such as the centromedian nucleus of the thalamus. Promising results from trials with ongoing enrollment have been seen with chronic subthreshold cortical stimulation. The potential for noninvasive neuromodulation is also significant (but as yet unproven), especially for patients who lack device candidacy due to medical comorbidity (e.g. coagulopathy), the presence of an intracranial lesion that requires routine radiographic surveillance, or when procedures are refused. Additional targets include external trigeminal nerve stimulation (TNS), repetitive transcranial stimulation (rTMS), transcranial direct current stimulation (tDCS), and transcutaneous vagus nerve stimulation, with varying degrees of success.
Tourette syndrome and other chronic tic disorders: an update on clinical management
Published in Expert Review of Neurotherapeutics, 2018
Davide Martino, Tamara M Pringsheim
Only smaller randomized controlled trials [97–99] have investigated the efficacy of DBS of the centromedian nucleus or centromedian–parafascicularis complex of the thalamus, using different designs, one of which was a delayed-start [99]. The trial by Okun et al. [98] also showed that a scheduled stimulation may lead to an improvement in tic severity which is comparable to classic, continuous stimulation, with the potential advantages of adaptive stimulation and gain in battery life. These studies provided, however, mixed and inconsistent results immediately after the randomization period, but reported a 48% decrease of YGTSS after longer open-label stimulation. A recent long-term (12–78 months) follow-up observational study of seven patients, on the other hand, revealed increasing imbalance of therapeutic effects and side effects, leading to turning off the stimulator or to changing the stimulation target with a new intervention in the majority of cases [100]. A systematic review and meta-analysis of pooled case reports and series, including 156 cases, reported an overall improvement of 53% in the YGTSS, favoring stimulation versus off stimulation with a SMD of 0.96, with no significant difference of effect between thalamic, Gpi, anterior limb of the internal capsule, and nucleus accumbens targets, and negative correlation between preoperative tic severity and outcome of thalamic stimulation [101].