Deep brain stimulation of the pulvinar thalamic nucleus for drug resistant epilepsy

Saturday, May 4, 2024

1:51 PM – 1:53 PM CT

Location: Booth 745 Neuro Spotlight

Presenting Author(s)

Arjun S. Chandran, MD

Epilepsy Surgery Fellow
Vivian L. Smith Department of Neurosurgery, UTHealth Science Center - Houston

Co-Author(s)

SJ

Stuti H. Joshi, MD

Epilepsy Fellow
McGovern Medical School at UTHealth Science Center - Houston, United States
SP

Sandipan Pati, MD

Associate Professor in Neurology
Texas Comprehensive Epilepsy Program, McGovern Medical School| The University of Texas Health Science Center at Houston, United States
JS

Jude Savarraj, n/a

Neuroscientist
McGovern Medical School at UTHealth Science Center - Houston, United States
Kathryn Snyder, B.E. (she/her/hers)

MD/PhD student
McGovern Medical School at UTHealth Science Center - Houston
Houston, TX, US
SS

Surya Suresh, MD

Epilepsy Fellow
McGovern Medical School at UTHealth Science Center - Houston, United States
Nitin Tandon, M.D. (he/him/his)

Attending Neurosurgeon
Vivian L. Smith Department of Neurosurgery, UTHealth Science Center - Houston
Houston, Texas, United States
Fernando De Nigris Vasconcellos, M.D.

M.D.
UTHealth Houston

Disclosure(s):

Arjun S. Chandran, MD: No financial relationships to disclose

Kathryn Snyder, B.E.: No financial relationships to disclose

Introduction: Deep brain stimulation (DBS) of the thalamus is an emerging therapeutic option for patients with drug resistant epilepsy (DRE). The pulvinar has extensive cortical connections with the temporal, parietal and occipital lobes leading to recent efforts to stimulate the pulvinar in patients with medication refractory posterior quadrant epilepsy PQE and temporal plus epilepsy (TPE). Here we present the first single center experience and initial case series of 5 patients who underwent bilateral DBS of the pulvinar for medication refractory TPE and PQE.

Methods: A single institution retrospective review of five patients who underwent bilateral pulvinar DBS was performed. All patients had drug refractory TPE or PQE. Patients were followed for a minimum of 6 months postoperatively. Patients were reviewed monthly to optimize stimulation parameters and monitor for side effects. The location within the pulvinar of active electrode contacts producing the best seizure freedom outcome were identified.

Results: Of the 5 patients implanted one achieved an Engel outcome of 1b, one 2a and three an outcome of 3a. Mean seizure reduction was 76% with a decrease in the severity and post ictal confusion period reported in all patients. No significant side effects were noted. Stimulation of the medial pulvinar thalamic nucleus (MPTN) produced the best seizure outcome in all patients except for one. Interestingly this one patient with active contacts in the MPTN but also in more lateral and inferior locations had the most significant reduction in seizures.

Conclusion : This is the first report of patients with bilateral pulvinar DBS for DRE. Our results demonstrate stimulation of the pulvinar and in particular the MPTN is a viable option for patients with non lesional, PQE/TPE. MPTN DBS is safe and well tolerated. The optimal target for stimulation and role of open vs closed loop stimulation should be delineated in future studies.