Initial Single-Center Outcomes Following Anterior Thalamic Nucleus Deep Brain Stimulation for Drug-Resistant Epilepsy
Abstract number :
3.466
Submission category :
9. Surgery / 9A. Adult
Year :
2023
Submission ID :
1451
Source :
www.aesnet.org
Presentation date :
12/4/2023 12:00:00 AM
Published date :
Authors :
Presenting Author: Kevin Bode Padron, BS – Duke University
Prince Antwi, MD – Duke University; Prachi Parikh, MD – Duke University; Derek Southwell, MD, PhD – Duke University
Rationale:
Deep brain stimulation (DBS) of the anterior thalamic nucleus (ANT) was approved as a treatment for drug-resistant focal epilepsy in the United States in mid-2018. Patient outcomes following ANT DBS have been evaluated primarily through the multi-center SANTE (Stimulation of the Anterior Nucleus of the Thalamus for Epilepsy) study. Our objective here was to evaluate patient outcomes following our center’s implementation of ANT DBS treatment, and to assess the generalizability of SANTE data with respect to our early experiences.
Methods:
We conducted a retrospective study of patient outcomes data for the initial 10 cases of ANT DBS performed at Duke University between May 2019 and February 2022 (mean follow-up period, 1016 days; range, 356 days – 1520 days).
Results:
The mean patient age at surgical treatment was 30.5 years (19-46 years) and the mean duration of drug-resistant epilepsy was 14.2 years (range, 3-34 years). The median baseline seizure frequency in the six months preceding DBS was 22.5 seizures per month (range, 1-165 seizures/month). The mean reduction in seizure frequency was 56.2% at 0-6 months (range, 13% - 97.1%; standard deviation (SD), 29.7%; n = 10 patients), 65.5% (range, 0% - 100%; SD, 35.8%; n = 8) at 6-12 months, 56.0% at 12-24 months (range, 0% - 99.5%; SD, 42.8%; n = 9), 63.8% at 24-36 months (range, 0% - 98.4%; SD, 47.0% n = 6), and 72.7% at 36-48 months (range, 0% - 99.7%; SD, 42.0%; n = 5). At last follow-up, the mean reduction in seizure frequency was 78.9% (range, 0 -100%; SD = 32.2% n = 10). At last follow-up, 90% of patients (9 of 10) had experienced > 50% reduction in seizure frequency. Daily anti-epileptic drug doses were decreased in 40% (4 of 10) of patients and increased in 40% (4 of 10) of patients. All patients received bilateral intermittent stimulation (1 minute on-cycle and 4 to 5 minute off-cycle), with a mean stimulation intensity of 4.1V (range, 1.5V – 7V), a pulse frequency of 145Hz, and a pulse width of 90 µs. Adverse events (deep vein thrombosis) occurred in one patient (10%).
Conclusions:
These data indicate that ANT DBS was implemented as an effective and safe treatment at our epilepsy center. Patient seizure outcomes resembled those described by the SANTE study and other single-center reports, adding to evidence that ANT DBS can yield significant seizure reduction in carefully selected patients.
Funding: None
Surgery