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Deep brain stimulation for treatment of the epilepsies: the centromedian thalamic target.

Abstract
Electrical stimulation (ES) of the thalamic centromedian nucleus (CMN) has been proposed as a minimally invasive alternative for the treatment of difficult-to-control seizures of multifocal origin and seizures that are generalized from the onset. ES intends to interfere with seizure propagation in a non-specific manner through the thalamic system. By adopting a frontal parasagittal approach and based on anterior-posterior (AC-PC) commissure intersection, deep brain stimulation (DBS) electrodes are stereotactically inserted. Electrophysiologic confirmation of electrodes position is accomplished by eliciting cortical recruiting responses and direct current (DC) shifts by low- and high-frequency stimulation through the electrodes. Cycling mode of bipolar stimulation has been used at 60-130 Hz, 0.45 msec, 2.5-3.5 V, 1 min ON in one side 4 min OFF, 1 min ON in the other side and 4 min OFF forward and back for 24h. ES of CMN significantly decreases generalized seizures of cortical origin and focal motor seizures. Best results are obtained in non-focal generalized tonic clonic seizures and atypical absences of the Lennox-Gastaut syndrome. Experience has indicated that the most effective target for seizure control is the thalamic parvocellular centromedian subnucleus.
AuthorsF Velasco, A L Velasco, M Velasco, F Jiménez, J D Carrillo-Ruiz, G Castro
JournalActa neurochirurgica. Supplement (Acta Neurochir Suppl) Vol. 97 Issue Pt 2 Pg. 337-42 ( 2007) ISSN: 0065-1419 [Print] Austria
PMID17691321 (Publication Type: Clinical Trial, Journal Article)
Topics
  • Adolescent
  • Adult
  • Child
  • Child, Preschool
  • Deep Brain Stimulation (methods)
  • Electroencephalography (methods)
  • Epilepsy (pathology, therapy)
  • Female
  • Humans
  • Intralaminar Thalamic Nuclei (physiopathology)
  • Magnetic Resonance Imaging (methods)
  • Male
  • Treatment Outcome

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