Abstract
Deep brain stimulation (DBS) of the thalamic nuclei for the treatment of drug-resistant
epilepsy (DRE) has been investigated for decades. In recent years, DBS targeting the
anterior nucleus of the thalamus (ANT) was approved by CE and FDA for the treatment
of focal-onset DRE in light of the results from the multicentric randomized controlled
SANTE trial. However, stereotactic targeting of thalamic nuclei is not straightforward
because of the low contrast definition among thalamic nuclei on the current MRI sequences.
When the FGATIR sequence is added to the preoperative MRI protocol, the mammillothalamic
tract can be identified and used as a visible landmark to directly target ANT. According
to the current evidence, the trans-ventricular trajectory allows the placement of
stimulating contact into the nucleus more frequently than the trans-cortical trajectory.
Another thalamic nucleus whose stimulation for the treatment of generalized DRE is
receiving increasing attention is the centromedian nucleus (CM). CM-DBS seems to be
particularly efficacious in patients suffering from Lennox-Gastault syndrome (LGS)
and the recent monocentric randomized controlled ESTEL trial also described a beneficial
“sweet-spot”. However, CM targeting is still based on indirect stereotactic coordinates,
since acquisition times and post-processing techniques of the actual MRI sequences
are not applicable in clinical practice. Moreover, the results of the ESTEL trial
await confirmation from similar studies accounting for epileptic syndromes other than
LGS. Therefore, novel neuroimaging approaches are advisable to improve the surgical
targeting of CM and potentially tailor the stimulation based on the patient's specific
epileptic phenotype.
Keywords
Abbreviations:
ANT (anterior nucleus of the thalamus), CM (centromedian nucleus), DBS (deep brain stimulation), DRE (drug-resistant epilepsy), EDGE-MICRA (3D edge-enhancing gradient eco with multi-imaging co-registration and averaging), FGATIR (fast gray matter acquisition T1 inversion recovery), LGS (Lennox-Gastault syndrome), MMT (mammillothalamic tract), MP2RAGE (magnetization prepared 2 rapid gradient echo), MRI (magnetic resonance imaging), QSM (quantitative susceptibility mapping)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: January 14, 2023
Accepted:
January 12,
2023
Received in revised form:
January 10,
2023
Received:
November 11,
2022
Identification
Copyright
© 2023 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.
