====== Subiculum stimulation ======
 

[[Evidence]] has been provided that the [[subiculum]] may play an important role in the generation of [[seizure]]s.[[ Electrostimulation]] at this target has been reported to have [[anticonvulsant]] effects in kindling and [[pilocarpine rat model]]s, while in a clinical study of [[hippocampal deep brain stimulation]] (DBS), contacts closest to the subiculum were associated with a better anticonvulsive effect.

Vázquez-Barrón et al. from the Unit of Functional Neurosurgery, Stereotaxy and Radiosurgery, General Hospital of [[Mexico City]],  evaluated the effect of Electrostimulation of the subiculum in patients with refractory [[mesial temporal lobe epilepsy]] (MTLE) who have [[hippocampal sclerosis]] (HS).

Six patients with refractory MTLE and HS, who had [[focal impaired-awareness seizures]] (FIAS) and [[focal to bilateral tonic-clonic seizures]] (FBTCS), had DBS electrodes implanted in the subiculum. During the first month after implantation, all patients were OFF stimulation, then they all completed an open-label follow-up of 24 months ON stimulation. DBS parameters were set at 3 V, 450 µs, 130 Hz, cycling stimulation 1 min ON, 4 min OFF.

There was a mean reduction of 49.16% (±SD 41.65) in total seizure number (FIAS + FBTCS) and a mean reduction of 67.93% (±SD 33.33) in FBTCS at 24 months. FBTCS decreased significantly with respect to baseline, starting from month 2 ON stimulation.

[[Subiculum stimulation]] is effective for [[focal to bilateral tonic-clonic seizures]] (FBTCS) reduction in patients with [[mesial temporal lobe epilepsy]] (MTLE) and [[hippocampal sclerosis]] (HS), suggesting that the [[subiculum]] mediates the generalization rather than the genesis of mesial temporal lobe seizures. Better results are observed at longer follow-up times
((Vázquez-Barrón D, Cuéllar-Herrera M, Velasco F, Velasco AL. Electrostimulation of Subiculum for the Treatment of Refractory Mesial Temporal Lobe Epilepsy with Hippocampal Sclerosis: A 2-Year Follow-Up Study. Stereotact Funct Neurosurg. 2020 Oct 28:1-8. doi: 10.1159/000510295. Epub ahead of print. PMID: 33113540.)).
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Glangetas et al. reported that high-frequency stimulation of the vSUB (HFSvSUB) over-activates ventral tegmental area (VTA) dopamine neurons in vivo and triggers long-lasting modifications of synaptic transmission measured ex vivo. This potentiation is caused by NMDA-dependent plastic changes occurring in the bed nucleus of the stria terminalis (BNST). Finally, we report that the modification of the BNST-VTA neural circuits induced by HFSvSUB potentiates locomotor activity induced by a sub-threshold dose of cocaine. This findings unravel a neuronal circuit encoding behavioral effects of cocaine in rats and highlight the importance of adaptive modifications in the BNST, a structure that influences motivated behavior as well as maladaptive behaviors associated with addiction
((Glangetas C, Fois GR, Jalabert M, Lecca S, Valentinova K, Meye FJ, Diana M, Faure P, Mameli M, Caille S, Georges F. Ventral Subiculum Stimulation Promotes Persistent Hyperactivity of Dopamine Neurons and Facilitates Behavioral Effects of Cocaine. Cell Rep. 2015 Dec 15;13(10):2287-96. doi: 10.1016/j.celrep.2015.10.076. Epub 2015 Nov 25. PMID: 26628379.)). 

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