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Dbs and epilepsy

Tommi Nora, Hanna Heinonen, Mirja Tenhunen, Sirpa Rainesalo, Soila Järvenpää, Kai Lehtimäki, Jukka Peltola
Deep brain stimulation (DBS) of the anterior nucleus of the thalamus (ANT) is a method of neuromodulation used for refractory focal epilepsy. We report a patient suffering from drug-resistant epilepsy who developed novel visual symptoms and atypical seizures with the onset of ANT-DBS therapy. Rechallenge under video electroencephalography recording confirmed that lowering the stimulation voltage alleviated these symptoms. Subsequent stimulation with the initial voltage value did not cause the recurrence of either the visual symptoms or the new seizure type, and appeared to alleviate the patient's seizures in long-term follow-up...
2018: Frontiers in Neurology
Paul Boon, Elien De Cock, Ann Mertens, Eugen Trinka
PURPOSE OF REVIEW: Neurostimulation is becoming an increasingly accepted treatment alternative for patients with drug-resistant epilepsy (DRE) who are unsuitable surgery candidates. Standardized guidelines on when or how to use the various neurostimulation modalities are lacking. We conducted a systematic review on the currently available neurostimulation modalities primarily with regard to effectiveness and safety. RECENT FINDINGS: For vagus nerve stimulation (VNS), there is moderate-quality evidence for its effectiveness in adults with drug-resistant partial epilepsies...
April 2018: Current Opinion in Neurology
Marlena Hupalo, Rafal Wojcik, Dariusz J Jaskolski
BACKGROUND: Results of DBS of ATN in refractory epilepsy depend on accuracy of the electrode's location. We searched for characteristic intraoperative, intracerebral EEG recording pattern from anterior thalamic nuclei (ATNs) as a biological marker for verifying the electrode's position. METHODS: There were six patients with refractory epilepsy scheduled for deep brain stimulation (DBS) procedure. At surgery, to map the target, we recorded EEG from each lead of DBS electrodes...
February 6, 2018: Neurologia i Neurochirurgia Polska
Alexander I Tröster
In the USA, the Food and Drug Administration (FDA) has approved deep brain stimulation (DBS) devices for the treatment of Parkinson's disease (PD), essential tremor (ET), dystonia, and obsessive compulsive disorder (OCD). DBS has been approved for these same conditions in Europe, but, additionally the European Commission (EC) has granted the Conformité Européenne (CE) Mark for DBS as adjunctive treatment for partial-onset seizures in adults with medically refractory epilepsy. In this issue of EJN Budman and colleagues [1] briefly review the range of neurologic conditions that might constitute promising new indications for DBS...
February 12, 2018: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
Óscar Romero-Osorio, Sebastián Gil-Tamayo, Daniel Nariño, Diego Rosselli
PURPOSE: Perform a systematic review of the literature on the effects of vagus nerve stimulation (VNS), deep brain stimulation (DBS) and epilepsy surgery in subjective and objective sleep parameters. METHODS: We performed a literature search in the main medical databases: Medline, Embase, Cochrane, DARE and LILACS, looking for studies that evaluated the effects of VNS, DBS or epilepsy surgery on sleep parameters. In all, 36 studies, coming from 11 countries, including reviews, cohort studies, case series and case reports were included...
January 31, 2018: Seizure: the Journal of the British Epilepsy Association
Benjamin B Whiting, Alexander C Whiting, Donald M Whiting
The use of deep brain stimulation (DBS) of the thalamus has been proven to be a safe and efficacious treatment for the management of many diseases. The most common indication for thalamic DBS remains essential tremor (ET), one of the most common movement disorders in the world. ET patients should be considered for surgical intervention when their tremor has demonstrated to be refractory to medication, a characteristic estimated to be present in roughly 50% of ET cases. Advantages of DBS over thalamotomy include its reversibility, the ability to adjust stimulation settings to optimize efficacy and minimize side effects, the ability to perform bilateral procedures safely, and an association with a lower risk of postoperative cognitive problems...
2018: Progress in Neurological Surgery
Irene E Harmsen, Nathan C Rowland, Richard A Wennberg, Andres M Lozano
BACKGROUND: Deep brain stimulation (DBS) is an important form of neuromodulation that is being applied to patients with motor, mood, or cognitive circuit disorders. Despite the efficacy and widespread use of DBS, the precise mechanisms by which it works remain unknown. Over the last decade, magnetoencephalography (MEG) has become an important functional neuroimaging technique used to study DBS. OBJECTIVE: This review summarizes the literature related to the use of MEG to characterize the effects of DBS...
January 4, 2018: Brain Stimulation
Tim A M Bouwens van der Vlis, Olaf E M G Schijns, Frédéric L W V J Schaper, Govert Hoogland, Pieter Kubben, Louis Wagner, Rob Rouhl, Yasin Temel, Linda Ackermans
Despite the use of first-choice anti-epileptic drugs and satisfactory seizure outcome rates after resective epilepsy surgery, a considerable percentage of patients do not become seizure free. ANT-DBS may provide for an alternative treatment option in these patients. This literature review discusses the rationale, mechanism of action, clinical efficacy, safety, and tolerability of ANT-DBS in drug-resistant epilepsy patients. A review using systematic methods of the available literature was performed using relevant databases including Medline, Embase, and the Cochrane Library pertaining to the different aspects ANT-DBS...
January 6, 2018: Neurosurgical Review
Kuldeep Kumar Namdev, Jaya Dwivedi, Deepak Chandra Chilkoti, Swapnil Sharma
Lamotrigine (LTZ) is a phenyltriazine derivative which belongs to anti-epileptic drugs (AEDs) class and prescribed as mono- or adjunctive-therapy in treatment of epilepsy. Therapeutic drug monitoring (TDM) of AEDs provides a valid clinical tool in optimization of overall therapy. However, TDM is challenging due to the high biological samples (plasma/blood) storage/shipment costs and the limited availability of laboratories providing TDM services. Sampling in the form of dry plasma spot (DPS) or dry blood spot (DBS) are suitable alternative to overcome these issues...
January 1, 2018: Journal of Chromatography. B, Analytical Technologies in the Biomedical and Life Sciences
Michael C H Li, Mark J Cook
OBJECTIVES: To review clinical evidence on the antiepileptic effects of deep brain stimulation (DBS) for drug-resistant epilepsy, its safety, and the factors influencing individual outcomes. METHODS: A comprehensive search of the medical literature (PubMed, Medline) was conducted to identify relevant articles investigating DBS therapy for drug-resistant epilepsy. Reference lists of these articles were used to source further articles. RESULTS: Stimulation of the anterior nucleus of the thalamus (ANT) and hippocampus (HC) has been shown to decrease the frequency of refractory seizures...
February 2018: Epilepsia
Naci Balak, Ece Balkuv, Ali Karadag, Recep Basaran, Huseyin Biceroglu, Buruç Erkan, Necmettin Tanriover
Very recently, neuromodulation through deep brain stimulation (DBS) has appeared as a new surgical procedure in the treatment of some types of dementia and epilepsy. The mammillothalamic and the mammillotegmental tracts are involved among the new targets. To our knowledge, a review article focused specifically on these mammillary body efferents is lacking in the medical literature. Their contribution to memory is, regrettably, often overlooked. There is evidence that mammillary bodies can contribute to memory independently from hippocampal formation, but the mechanism is not yet known...
November 9, 2017: World Neurosurgery
Felix S Gubler, Linda Ackermans, Pieter L Kubben, Aysun Damci, Mark L Kuijf, Mayke Oosterloo, R Jeroen Vermeulen, Sarah Hescham, Ersoy Kocabicak, Erkan Kurt, Yasin Temel
Background: To report our experience of infections in deep brain stimulation (DBS) surgeries comparing shaving versus no shaving of cranial hair. Nonshaving is strongly preferred by patients due to aesthetic and psychological factors. Methods: This study is a prospective follow-up of the infection rate in 43 nonshaven DBS cases between April 2014 and December 2015 compared to our former infection rate with shaving in our center. Minimum follow-up was 6 months. All patients, except 7 epilepsy patients, received implantation of the electrodes together with the extension cables and internal pulse generator in one session...
2017: Surgical Neurology International
Seong Hoon Kim, Sung Chul Lim, Dong Won Yang, Jeong Hee Cho, Byung-Chul Son, Jiyeon Kim, Seung Bong Hong, Young-Min Shon
OBJECTIVE: Deep brain stimulation (DBS) of the centromedian thalamic nucleus (CM) can be an alternative treatment option for intractable epilepsy patients. Since CM may be involved in widespread cortico-subcortical networks, identification of the cortical sub-networks specific to the target stimuli may provide further understanding on the underlying mechanisms of CM DBS. Several brain structures have distinguishing brain connections that may be related to the pivotal propagation and subsequent clinical effect of DBS...
2017: Neuropsychiatric Disease and Treatment
Seong Hoon Kim, Sung Chul Lim, Jiyeon Kim, Byung-Chul Son, Kyung Jin Lee, Young-Min Shon
PURPOSE: Anterior thalamic deep brain stimulation (ATN DBS) is an emerging, effective treatment for patients with drug-resistant epilepsy, but long-term results on its efficacy and safety are lacking. To evaluate the long-term efficacy and safety of ATN DBS treatment, as well as predictors of its success, in patients with drug-refractory epilepsy (DRE). METHOD: We retrospectively studied clinical outcomes in 29 consecutive refractory epilepsy patients treated by a single DBS team (two neurosurgeons, four neurologists) over an 11-year period, for whom follow-up was performed for up to 137 months (mean, 74...
November 2017: Seizure: the Journal of the British Epilepsy Association
Niels Hansen, Leila Chaieb, Marlene Derner, Kevin G Hampel, Christian E Elger, Rainer Surges, Bernhard Staresina, Nikolai Axmacher, Juergen Fell
BACKGROUND: Deep brain stimulation (DBS) of the human entorhinal area using 50 Hz pulses has revealed conflicting results regarding memory performance. Moreover, its impact on memory-related hippocampal potentials has not yet been investigated. METHODS: We recorded data from seven epilepsy patients implanted with depth electrodes in the entorhinal cortex, hippocampus, amygdala and parahippocampal cortex. Entorhinal DBS (bipolar, biphasic 50 Hz pulses, on- and off-cycles of 15 s) was applied with low amplitude (0...
October 16, 2017: Hippocampus
Elenn Soares Ferreira, Laís Gabrielle Vieira, Daniela Macedo Moraes, Beatriz O Amorim, Jackeline Moraes Malheiros, Clement Hamani, Luciene Covolan
INTRODUCTION AND OBJECTIVES: Cognitive impairment is a significant comorbidity of temporal lobe epilepsy that is associated with extensive hippocampal cell loss. Deep brain stimulation (DBS) of the anterior thalamic nucleus (ANT) has been used for the treatment of refractory partial seizures. In the pilocarpine model of epilepsy, ANT DBS applied during status epilepticus (SE) reduces hippocampal inflammation and apoptosis. When given to chronic epileptic animals it reduces hippocampal excitability and seizure frequency...
September 28, 2017: Neuromodulation: Journal of the International Neuromodulation Society
Paul H Stypulkowski, Scott R Stanslaski, Jonathon E Giftakis
BACKGROUND: Deep Brain Stimulation (DBS) within the Papez circuit is under investigation as a treatment for epilepsy and Alzheimer's disease. We previously reported the effects of stimulation at nodes within this network (anterior thalamic nucleus and hippocampus) on hippocampal activity in a large animal model, using a chronic implantable, clinical-grade system that permits concurrent stimulation and recording. OBJECTIVE: In this study we extended earlier work to compare the effects of fornix DBS on evoked potentials (EPs) and local field potential (LFP) activity within the hippocampus, and to assess closed-loop stimulation...
September 6, 2017: Brain Stimulation
Bowen Chang, Jiwen Xu
OBJECTIVE: Conflicting conclusions have been reported regarding predictors of deep brain stimulation (DBS) outcome in patients with refractory temporal lobe epilepsy (TLE). The main goal of this meta-analysis study was to identify possible predictors of remarkable seizure reduction (RSR). METHODS: We conducted a comprehensive search of English-language literature published since 1990 and indexed in PubMed, Embase, and the Cochrane Library that addressed seizure outcomes in patients who underwent DBS for refractory TLE...
September 18, 2017: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
Matthew P Wilson, Emma J Footitt, Apostolos Papandreou, Mari-Liis Uudelepp, Ronit Pressler, Danielle C Stevenson, Camila Gabriel, Mel McSweeney, Matthew Baggot, Derek Burke, Tommy Stödberg, Kate Riney, Manuel Schiff, Simon J R Heales, Kevin A Mills, Paul Gissen, Peter T Clayton, Philippa B Mills
We report the development of a rapid, simple, and robust LC-MS/MS-based enzyme assay using dried blood spots (DBS) for the diagnosis of pyridox(am)ine 5'-phosphate oxidase (PNPO) deficiency (OMIM 610090). PNPO deficiency leads to potentially fatal early infantile epileptic encephalopathy, severe developmental delay, and other features of neurological dysfunction. However, upon prompt treatment with high doses of vitamin B6, affected patients can have a normal developmental outcome. Prognosis of these patients is therefore reliant upon a rapid diagnosis...
September 5, 2017: Analytical Chemistry
Jari Peräkylä, Lihua Sun, Kai Lehtimäki, Jukka Peltola, Juha Öhman, Timo Möttönen, Keith H Ogawa, Kaisa M Hartikainen
The mediodorsal nucleus of the thalamus (MD), with its extensive connections to the lateral pFC, has been implicated in human working memory and executive functions. However, this understanding is based solely on indirect evidence from human lesion and imaging studies and animal studies. Direct, causal evidence from humans is missing. To obtain direct evidence for MD's role in humans, we studied patients treated with deep brain stimulation (DBS) for refractory epilepsy. This treatment is thought to prevent the generalization of a seizure by disrupting the functioning of the patient's anterior nuclei of the thalamus (ANT) with high-frequency electric stimulation...
December 2017: Journal of Cognitive Neuroscience
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