Deep Brain Stimulation in Epilepsy: A Role for Modulation of the Mammillothalamic Tract in Seizure Control?

Frederic L. W. V. J. Schaper; Birgit R. Plantinga; Albert J. Colon; G. Louis Wagner; Paul Boon; Nadia Blom; Erik D. Gommer; Govert Hoogland; Linda Ackermans; Rob P. W. Rouhl; Yasin Temel

doi:10.1093/neuros/nyaa141

Deep Brain Stimulation in Epilepsy: A Role for Modulation of the Mammillothalamic Tract in Seizure Control?

Frederic L. W. V. J. Schaper^*, Birgit R. Plantinga, Albert J. Colon, G. Louis Wagner, Paul Boon, Nadia Blom, Erik D. Gommer, Govert Hoogland, Linda Ackermans, Rob P. W. Rouhl, Yasin Temel

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

25 Citations (Web of Science)

Abstract

BACKGROUND: Deep brain stimulation of the anterior nucleus of the thalamus (ANT-DBS) can improve seizure control for patients with drug-resistant epilepsy (DRE). Yet, one cannot overlook the high discrepancy in efficacy among patients, possibly resulting from differences in stimulation site.

OBJECTIVE: To test the hypothesis that stimulation at the junction of the ANT and mammillothalamic tract (ANT-MTT junction) increases seizure control.

METHODS: The relationship between seizure control and the location of the active contacts to the ANT-MIT junction was investigated in 20 patients treated with ANT-DBS for DRE. Coordinates and Euclidean distance of the active contacts relative to the ANT-MTT junction were calculated and related to seizure control. Stimulation sites were mapped by modelling the volume of tissue activation (VTA) and generating stimulation heat maps.

RESULTS: After 1 yr of stimulation, patients had a median 46% reduction in total seizure frequency, 50% were responders, and 20% of patients were seizure-free. The Euclidean distance of the active contacts to the ANT-MTT junction correlates to change in seizure frequency (r' = 0.24, P = .01) and is -30% smaller (P = .015) in responders than in nonresponders. VTA models and stimulation heat maps indicate a hot-spot at the ANT-MTT junction for responders, whereas non-responders had no evident hot-spot.

CONCLUSION: Stimulation at the ANT-MTT junction correlates to increased seizure control. Our findings suggest a relationship between the stimulation site and therapy response in ANT-DBS for epilepsy with a potential role for the MTT. DBS directed at white matter merits further exploration for the treatment of epilepsy.

Original language	English
Pages (from-to)	602-610
Number of pages	9
Journal	Neurosurgery
Volume	87
Issue number	3
DOIs	https://doi.org/10.1093/neuros/nyaa141
Publication status	Published - Sep 2020

Keywords

Neuromodulation
DRE
Drug-resistant epilepsy
Thalamus
Mammillothalamic tract
White matter stimulation
HIGH-FREQUENCY STIMULATION
ANTERIOR NUCLEUS
ELECTRICAL-STIMULATION
THALAMUS
TARGET
MRI
CIRCUITS

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10.1093/neuros/nyaa141Licence: CC BY-NC

Cite this

@article{139bd9e29426497bb1ea57eecbb14bc4,

title = "Deep Brain Stimulation in Epilepsy: A Role for Modulation of the Mammillothalamic Tract in Seizure Control?",

abstract = "BACKGROUND: Deep brain stimulation of the anterior nucleus of the thalamus (ANT-DBS) can improve seizure control for patients with drug-resistant epilepsy (DRE). Yet, one cannot overlook the high discrepancy in efficacy among patients, possibly resulting from differences in stimulation site.OBJECTIVE: To test the hypothesis that stimulation at the junction of the ANT and mammillothalamic tract (ANT-MTT junction) increases seizure control.METHODS: The relationship between seizure control and the location of the active contacts to the ANT-MIT junction was investigated in 20 patients treated with ANT-DBS for DRE. Coordinates and Euclidean distance of the active contacts relative to the ANT-MTT junction were calculated and related to seizure control. Stimulation sites were mapped by modelling the volume of tissue activation (VTA) and generating stimulation heat maps.RESULTS: After 1 yr of stimulation, patients had a median 46% reduction in total seizure frequency, 50% were responders, and 20% of patients were seizure-free. The Euclidean distance of the active contacts to the ANT-MTT junction correlates to change in seizure frequency (r' = 0.24, P = .01) and is -30% smaller (P = .015) in responders than in nonresponders. VTA models and stimulation heat maps indicate a hot-spot at the ANT-MTT junction for responders, whereas non-responders had no evident hot-spot.CONCLUSION: Stimulation at the ANT-MTT junction correlates to increased seizure control. Our findings suggest a relationship between the stimulation site and therapy response in ANT-DBS for epilepsy with a potential role for the MTT. DBS directed at white matter merits further exploration for the treatment of epilepsy.",

keywords = "Neuromodulation, DRE, Drug-resistant epilepsy, Thalamus, Mammillothalamic tract, White matter stimulation, HIGH-FREQUENCY STIMULATION, ANTERIOR NUCLEUS, ELECTRICAL-STIMULATION, THALAMUS, TARGET, MRI, CIRCUITS",

author = "Schaper, {Frederic L. W. V. J.} and Plantinga, {Birgit R.} and Colon, {Albert J.} and Wagner, {G. Louis} and Paul Boon and Nadia Blom and Gommer, {Erik D.} and Govert Hoogland and Linda Ackermans and Rouhl, {Rob P. W.} and Yasin Temel",

year = "2020",

month = sep,

doi = "10.1093/neuros/nyaa141",

language = "English",

volume = "87",

pages = "602--610",

journal = "Neurosurgery",

issn = "0148-396X",

publisher = "Oxford University Press",

number = "3",

}

TY - JOUR

T1 - Deep Brain Stimulation in Epilepsy

T2 - A Role for Modulation of the Mammillothalamic Tract in Seizure Control?

AU - Schaper, Frederic L. W. V. J.

AU - Plantinga, Birgit R.

AU - Colon, Albert J.

AU - Wagner, G. Louis

AU - Boon, Paul

AU - Blom, Nadia

AU - Gommer, Erik D.

AU - Hoogland, Govert

AU - Ackermans, Linda

AU - Rouhl, Rob P. W.

AU - Temel, Yasin

PY - 2020/9

Y1 - 2020/9

N2 - BACKGROUND: Deep brain stimulation of the anterior nucleus of the thalamus (ANT-DBS) can improve seizure control for patients with drug-resistant epilepsy (DRE). Yet, one cannot overlook the high discrepancy in efficacy among patients, possibly resulting from differences in stimulation site.OBJECTIVE: To test the hypothesis that stimulation at the junction of the ANT and mammillothalamic tract (ANT-MTT junction) increases seizure control.METHODS: The relationship between seizure control and the location of the active contacts to the ANT-MIT junction was investigated in 20 patients treated with ANT-DBS for DRE. Coordinates and Euclidean distance of the active contacts relative to the ANT-MTT junction were calculated and related to seizure control. Stimulation sites were mapped by modelling the volume of tissue activation (VTA) and generating stimulation heat maps.RESULTS: After 1 yr of stimulation, patients had a median 46% reduction in total seizure frequency, 50% were responders, and 20% of patients were seizure-free. The Euclidean distance of the active contacts to the ANT-MTT junction correlates to change in seizure frequency (r' = 0.24, P = .01) and is -30% smaller (P = .015) in responders than in nonresponders. VTA models and stimulation heat maps indicate a hot-spot at the ANT-MTT junction for responders, whereas non-responders had no evident hot-spot.CONCLUSION: Stimulation at the ANT-MTT junction correlates to increased seizure control. Our findings suggest a relationship between the stimulation site and therapy response in ANT-DBS for epilepsy with a potential role for the MTT. DBS directed at white matter merits further exploration for the treatment of epilepsy.

AB - BACKGROUND: Deep brain stimulation of the anterior nucleus of the thalamus (ANT-DBS) can improve seizure control for patients with drug-resistant epilepsy (DRE). Yet, one cannot overlook the high discrepancy in efficacy among patients, possibly resulting from differences in stimulation site.OBJECTIVE: To test the hypothesis that stimulation at the junction of the ANT and mammillothalamic tract (ANT-MTT junction) increases seizure control.METHODS: The relationship between seizure control and the location of the active contacts to the ANT-MIT junction was investigated in 20 patients treated with ANT-DBS for DRE. Coordinates and Euclidean distance of the active contacts relative to the ANT-MTT junction were calculated and related to seizure control. Stimulation sites were mapped by modelling the volume of tissue activation (VTA) and generating stimulation heat maps.RESULTS: After 1 yr of stimulation, patients had a median 46% reduction in total seizure frequency, 50% were responders, and 20% of patients were seizure-free. The Euclidean distance of the active contacts to the ANT-MTT junction correlates to change in seizure frequency (r' = 0.24, P = .01) and is -30% smaller (P = .015) in responders than in nonresponders. VTA models and stimulation heat maps indicate a hot-spot at the ANT-MTT junction for responders, whereas non-responders had no evident hot-spot.CONCLUSION: Stimulation at the ANT-MTT junction correlates to increased seizure control. Our findings suggest a relationship between the stimulation site and therapy response in ANT-DBS for epilepsy with a potential role for the MTT. DBS directed at white matter merits further exploration for the treatment of epilepsy.

KW - Neuromodulation

KW - DRE

KW - Drug-resistant epilepsy

KW - Thalamus

KW - Mammillothalamic tract

KW - White matter stimulation

KW - HIGH-FREQUENCY STIMULATION

KW - ANTERIOR NUCLEUS

KW - ELECTRICAL-STIMULATION

KW - THALAMUS

KW - TARGET

KW - MRI

KW - CIRCUITS

U2 - 10.1093/neuros/nyaa141

DO - 10.1093/neuros/nyaa141

M3 - Article

C2 - 32421806

VL - 87

SP - 602

EP - 610

JO - Neurosurgery

JF - Neurosurgery

SN - 0148-396X

IS - 3

ER -