====== Neocortical epilepsy ======
 
Neocortical [[epilepsy]] is a type of [[seizure]] disorder that can be either partial (focal) or generalized, in which the seizures originate in the [[neocortex]], part of the external surface layer of the brain.

===== Treatment =====

The [[pulvinar]] has remained largely unstudied as a [[neurostimulation]] target to treat [[refractory epilepsy]]. Because the pulvinar has connections with the [[posterior quadrant]], neurostimulation may be effective if applied to [[seizure]]s originating in this area. Burdette et al. performed a retrospective [[chart review]] of patients with regional [[neocortical epilepsy]] onsets in the posterior quadrant treated with [[Responsive neurostimulation]]. [[Demographics]], epilepsy history, clinical seizure frequencies, and [[neuropsychological test]]ing results were obtained from the [[chart]]. [[Electrocorticogram]] (ECoG) records stored by the [[RNS]] System were reviewed to evaluate electrographic seizure onset patterns. The patients were followed for 10, 12.5, and 15 months. All patients were responders (≥50% seizure reduction), and two of the three patients experienced a ≥90% reduction in seizures at the last follow-up. Pre- and postsurgical neuropsychological evaluations were compared for two of the patients, and there was no evidence of cognitive decline found in either patient. Interestingly, mild [[cognitive]] improvements were reported. The third patient had only postimplant neuropsychological testing data available. Findings for this patient suggested [[executive dysfunction]] that was present prior to the RNS System which did not worsen with surgery. A visual inspection of ECoGs revealed near-simultaneous seizure onsets in neocortical and pulvinar leads in two patients. Seizure onsets in the third patient were more variable. This is the first published report of brain-responsive neurostimulation targeting the [[pulvinar]] to treat refractory regional onset epilepsy of posterior quadrant origin
((Burdette D, Mirro EA, Lawrence M, Patra SE. Brain-responsive corticothalamic stimulation in the pulvinar nucleus for the treatment of regional [[neocortical epilepsy]]: A case series. Epilepsia Open. 2021 Sep;6(3):611-617. doi: 10.1002/epi4.12524. Epub 2021 Aug 3. PMID: 34268893; PMCID: PMC8408587.))
((Pizzo F, Carron R, Bartolomei F. Letter to Brain-responsive corticothalamic stimulation in the pulvinar nucleus for the treatment of regional [[neocortical epilepsy]]: A case series. Epilepsia Open. 2022 Aug 2. doi: 10.1002/epi4.12611. Epub ahead of print. PMID: 35917183.)).