Deep brain stimulation for drug-resistant epilepsy [Neurosurgery Wiki]

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====== Deep brain stimulation for drug-resistant epilepsy ======

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see [[Drug-resistant epilepsy treatment]]

[[Deep Brain Stimulation]] (DBS) for [[Drug-Resistant Epilepsy]] is an emerging [[neuromodulation]] therapy that targets specific deep brain structures to reduce the frequency and severity of seizures in patients who do not respond to medications and are not candidates for [[Resective epilepsy surgery]].

🔍 Overview
Drug-resistant epilepsy (DRE): Defined as failure to achieve sustained seizure freedom after adequate trials of two or more appropriately chosen and used antiepileptic drugs.

DBS involves implanting electrodes in targeted brain regions and delivering electrical impulses via an implanted pulse generator (like a pacemaker for the brain).

🎯 Common Targets
[[Anterior nucleus of the thalamus]] (ANT)

Most well-studied target.

Part of the [[Papez circuit]] is involved in seizure propagation.

Stimulated bilaterally.

SANTE trial (Stimulation of the Anterior Nucleus of the Thalamus for Epilepsy) showed significant seizure reduction and long-term benefit.

[[Centromedian nucleus]] of the [[thalamus]] (CM)

More common in generalized or [[Lennox-Gastaut syndrome]].

Targeted at children and adults with generalized or multifocal epilepsy.

Hippocampus, subthalamic nucleus, cerebellum, and nucleus accumbens

Investigational targets.

📊 Evidence – SANTE Trial Highlights

Multicenter, randomized controlled trial.

100 patients with partial-onset seizures.

Seizure reduction:

~40% at 1 year.

Up to 75% at 5 years.

Safety:

Well tolerated overall.

Adverse events: device-related (e.g., lead migration, infection), stimulation-related (e.g., depression, memory impairment), though typically manageable.

✅ Indications & Criteria
Adults with focal epilepsy not amenable to resective surgery.

At least 2 failed medications.

Frequent, disabling seizures.

MRI may be normal or show non-resectable abnormalities.

Neuropsychological and psychiatric evaluation essential prior to implantation.

===== Thalamic centromedian nucleus deep brain stimulation for drug-resistant epilepsy =====
[[Thalamic centromedian nucleus deep brain stimulation for drug-resistant epilepsy]]