World neurosurgery · 2026
Responsive Neurostimulation of the Centromedian Nucleus of the Thalamus for the Treatment of Drug-Resistant Idiopathic Generalized Epilepsy: A Retrospective Analysis of Efficacy and Exploratory Role of Different Stimulation Frequency Paradigms.
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Zillgitt Andrew J, Burdette David E, Manasseh Angelique M, Li Grace, Ferrari Paul, Zargar Bahram Sarvi, Yako Atheel W, Parres Christopher M, Patra Sanjay E, Staudt Michael D
Аннотация
OBJECTIVE: Closed-loop (responsive) neurostimulation (RNS) targeting the bilateral centromedian thalamic nucleus (CMN) is a safe and efficacious therapy for idiopathic generalized epilepsy (IGE). However, the optimal stimulation parameters have yet to be elucidated. The aims of this study were to review the efficacy of CMN-RNS in drug-resistant IGE and discuss the potential role of stimulation frequency in CMN-RNS programming.
METHODS: This study is a single-institution retrospective analysis of 10 patients with drug-resistant IGE who underwent CMN-RNS implantation. Initial therapy programming consisted of bipolar settings with opposite polarity between burst 1/2 and initial current 0.5 mA, charge density 0.5 μC/cm2, frequency 125 Hz, pulse width 160 μsec, and burst duration 500 msec. If patients experienced seizures or developed paresthesia with increasing charge density, they were transitioned to mid (10-100 Hz) or low frequency (<10 Hz) stimulation.
RESULTS: The mean age at surgery was 33 years, and mean epilepsy duration was 20 years prior to RNS implantation. Median post-implantation follow-up was 33.5 months. The median number of pre-implantation generalized tonic-clonic (GTC) seizures per year was 5.5, and post-RNS was 2.5. Overall, there was a median 85.5% reduction in GTC frequency from the pre-RNS baseline. The median GTC-free interval was 16 months, and 40% of patients were GTC-free at last follow-up.
CONCLUSIONS: The results of this cases series suggest CMN-RNS therapy in people with drug-resistant IGE may significantly reduce the frequency of GTC. Preliminary evidence may support alternative paradigms of mid and low-frequency stimulation when high-frequency stimulation is poorly tolerated or not efficacious.
METHODS: This study is a single-institution retrospective analysis of 10 patients with drug-resistant IGE who underwent CMN-RNS implantation. Initial therapy programming consisted of bipolar settings with opposite polarity between burst 1/2 and initial current 0.5 mA, charge density 0.5 μC/cm2, frequency 125 Hz, pulse width 160 μsec, and burst duration 500 msec. If patients experienced seizures or developed paresthesia with increasing charge density, they were transitioned to mid (10-100 Hz) or low frequency (<10 Hz) stimulation.
RESULTS: The mean age at surgery was 33 years, and mean epilepsy duration was 20 years prior to RNS implantation. Median post-implantation follow-up was 33.5 months. The median number of pre-implantation generalized tonic-clonic (GTC) seizures per year was 5.5, and post-RNS was 2.5. Overall, there was a median 85.5% reduction in GTC frequency from the pre-RNS baseline. The median GTC-free interval was 16 months, and 40% of patients were GTC-free at last follow-up.
CONCLUSIONS: The results of this cases series suggest CMN-RNS therapy in people with drug-resistant IGE may significantly reduce the frequency of GTC. Preliminary evidence may support alternative paradigms of mid and low-frequency stimulation when high-frequency stimulation is poorly tolerated or not efficacious.