Long-term efficacy and cognitive effects of bilateral hippocampal deep brain stimulation in patients with drug-resistant temporal lobe epilepsy

Deep brain stimulation (DBS) of the thalamic ventral intermediate nucleus is one of the main advanced neurosurgical treatments for drug-resistant tremor. However, not every patient may be eligible for this procedure. Nowadays, various other functional neurosurgical procedures are available. In particular cases, radiofrequency thalamotomy, focused ultrasound and radiosurgery are proven alternatives to DBS. Besides, other DBS targets, such as the posterior subthalamic area (PSA) or the dentato-rubro-thalamic tract (DRT), may be appraised as well. In this review, the clinical characteristics and pathophysiology of tremor syndromes, as well as long-term outcomes of DBS in different targets, will be summarized. The effectiveness and safety of lesioning procedures will be discussed, and an evidence-based clinical treatment approach for patients with drug-resistant tremor will be presented. Lastly, the future directions in the treatment of severe tremor syndromes will be elaborated.

Download Full-text

36. Long-Term Efficacy of Different Deep Brain Stimulation to Different Targets - What is the True Clinical Benefit?

Biological Psychiatry ◽

10.1016/j.biopsych.2019.03.050 ◽

2019 ◽

Vol 85 (10) ◽

pp. S15

Author(s):

Thomas Schlaepfer ◽

Hannah Kilian ◽

Bettina Bewernick ◽

Volker Coenen

Keyword(s):

Deep Brain Stimulation ◽

Brain Stimulation ◽

Clinical Benefit ◽

Term Efficacy ◽

Deep Brain

Download Full-text

Deep Brain Stimulation in Patients with Refractory Temporal Lobe Epilepsy

Epilepsia ◽

10.1111/j.1528-1167.2007.01005.x ◽

2007 ◽

Vol 48 (8) ◽

pp. 1551-1560 ◽

Cited By ~ 231

Author(s):

Paul Boon ◽

Kristl Vonck ◽

Veerle De Herdt ◽

Annelies Van Dycke ◽

Maarten Goethals ◽

...

Keyword(s):

Deep Brain Stimulation ◽

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Brain Stimulation ◽

Deep Brain

Download Full-text

Hippocampal deep brain stimulation in nonlesional refractory mesial temporal lobe epilepsy

Seizure ◽

10.1016/j.seizure.2016.01.018 ◽

2016 ◽

Vol 37 ◽

pp. 1-7 ◽

Cited By ~ 13

Author(s):

Hongbo Jin ◽

Wenling Li ◽

Changzheng Dong ◽

Jiang Wu ◽

Wenqing Zhao ◽

...

Keyword(s):

Deep Brain Stimulation ◽

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Brain Stimulation ◽

Mesial Temporal Lobe Epilepsy ◽

Mesial Temporal Lobe ◽

Deep Brain

Download Full-text

Anterior Nucleus Deep Brain Stimulation for Refractory Epilepsy

Neurosurgery ◽

10.1227/neu.0000000000001197 ◽

2016 ◽

Vol 78 (6) ◽

pp. 802-811 ◽

Cited By ~ 45

Author(s):

Vibhor Krishna ◽

Nicolas Kon Kam King ◽

Francesco Sammartino ◽

Ido Strauss ◽

Danielle M. Andrade ◽

...

Keyword(s):

Deep Brain Stimulation ◽

Seizure Frequency ◽

Brain Stimulation ◽

Refractory Epilepsy ◽

Term Outcome ◽

Long Term Outcome ◽

Anterior Nucleus ◽

Term Efficacy ◽

Deep Brain

Abstract BACKGROUND: Anterior nucleus (AN) deep brain stimulation (DBS) is a palliative treatment for medically refractory epilepsy. The long-term efficacy and the optimal target localization for AN DBS are not well understood. OBJECTIVE: To analyze the long-term efficacy of AN DBS and its predictors. METHODS: We performed a retrospective review of 16 patients who underwent AN DBS. We selected only patients with reliable seizure frequency data and at least a 1-year follow-up. We studied the duration of the seizure reduction after DBS insertion and before stimulation (the insertional effect) and its association with long-term outcome. We modeled the volume of activation using the active contacts, stimulation parameters, and postoperative imaging. The overlap of this volume was plotted in Montreal Neurological Institute 152 space in 7 patients with significant clinical efficacy. RESULTS: Nine patients reported a decrease in seizure frequency immediately after electrode insertion (insertional or microthalamotomy effect). The duration of insertional effect varied from 2 to 4 months. However, 1 patient had a long-term insertional effect of 36 months. Altogether, 11 patients reported >50% decrease in seizure frequency with long-term stimulation. The most common pattern of seizure control was immediate and sustained stimulation benefit (n = 8). In patients with long-term stimulation benefit, the efficacious target was localized in the anteroventral AN in close proximity to the mammillothalamic tract. CONCLUSION: AN DBS is efficacious in the control of seizure frequency in selected patients. An insertional effect is commonly observed (56%). The most efficacious site of stimulation appears to be the anteroventral AN.

Download Full-text

Long-term efficacy of deep brain stimulation for essential tremor

Neurology ◽

10.1212/wnl.0000000000007134 ◽

2019 ◽

Vol 92 (12) ◽

pp. e1378-e1386 ◽

Cited By ~ 22

Author(s):

Steffen Paschen ◽

Julia Forstenpointner ◽

Jos Becktepe ◽

Sebastian Heinzel ◽

Helge Hellriegel ◽

...

Keyword(s):

Deep Brain Stimulation ◽

Essential Tremor ◽

Brain Stimulation ◽

Rating Scale ◽

Rebound Effect ◽

Short Term ◽

Term Efficacy ◽

Secondary Outcomes ◽

Deep Brain

ObjectiveDeep brain stimulation (DBS) of the ventral intermediate thalamic nucleus (Vim) is established for medically refractory severe essential tremor (ET), but long-term efficacy is controversial.MethodsTwenty patients with ET with DBS had standardized video-documented examinations at baseline, in the stimulation-on condition at short term (13.1 ± 1.9 months since surgery, mean ± SEM), and in the stimulator switched on and off (stim-ON/OFF) at long term; all assessments were done between 32 and 120 months (71.9 ± 6.9 months) after implantation. The primary outcome was the Tremor Rating Scale (TRS) blindly assessed by 2 trained movement disorder neurologists. Secondary outcomes were TRS subscores A, B, and C; Archimedes spiral score; and activities of daily living score. At long-term follow-up, tremor was additionally recorded with accelerometry. The rebound effect after switching the stimulator off was assessed for 1 hour in a subgroup.ResultsTremor severity worsened considerably over time in both in the nonstimulated and stimulated conditions. Vim-DBS improved the TRS in the short term and long term significantly. The spiral score and functional measures showed similar improvements. All changes were highly significant. However, the stimulation effect was negatively correlated with time since surgery (ρ = −0.78, p < 0.001). This was also true for the secondary outcomes. Only one-third of the patients had a rebound effect terminated 60 minutes after the stimulator was switched off. Long-term worsening of the TRS was more profound during stim-ON than in the stim-OFF condition, indicating habituation to stimulation.ConclusionVim-DBS loses efficacy over the long term. Efforts are needed to improve the long-term efficacy of Vim-DBS.Classification of evidenceThis study provides Class IV evidence that for patients with medically refractory severe ET, the efficacy of Vim-DBS severely decreases over 10 years.

Download Full-text