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

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.

[1]  M Velasco,et al.  Role of the centromedian thalamic nucleus in the genesis, propagation and arrest of epileptic activity. An electrophysiological study in man. , 1993, Acta neurochirurgica. Supplementum.

[2]  M Velasco,et al.  Predictors in the treatment of difficult-to-control seizures by electrical stimulation of the centromedian thalamic nucleus. , 2000, Neurosurgery.

[3]  M Velasco,et al.  Electrocortical and behavioral responses produced by acute electrical stimulation of the human centromedian thalamic nucleus. , 1997, Electroencephalography and clinical neurophysiology.

[4]  M Velasco,et al.  Electrical Stimulation of the Centromedian Thalamic Nucleus in the Treatment of Convulsive Seizures: A Preliminary Report , 1987, Epilepsia.

[5]  J. Wheless,et al.  Vagus Nerve Stimulation in Children with Refractory Seizures Associated with Lennox–Gastaut Syndrome , 2001, Epilepsia.

[6]  H. Jasper,et al.  Diffuse projection systems: the integrative action of the thalamic reticular system. , 1949, Electroencephalography and clinical neurophysiology.

[7]  J. E. Skinner,et al.  THE NONSPECIFIC MEDIOTHALAMIC-FRONTOCORTICAL SYSTEM: ITS INFLUENCE ON ELECTROCORTICAL ACTIVITY AND BEHAVIOR , 1973 .

[8]  M. Velasco,et al.  Centromedian nucleus stimulation for epilepsy: Clinical, electroencephalographic, and behavioral observations , 2002 .

[9]  D. Lindsley,et al.  Role of Orbital Cortex in Regulation of Thalamocortical Electrical Activity , 1965, Science.

[10]  M. Velasco,et al.  Neurobiological Background for Performing Surgical Intervention in the Inferior Thalamic Peduncle for Treatment of Major Depression Disorders , 2005, Neurosurgery.

[11]  G. Colicchio,et al.  Callosotomy for severe epilepsies with generalized seizures: Outcome and prognostic factors , 2005, Acta Neurochirurgica.