Case Report: Responsive Neurostimulation of the Centromedian Thalamic Nucleus for the Detection and Treatment of Seizures in Pediatric Primary Generalized Epilepsy
Up to 20% of pediatric patients with primary generalized epilepsy (PGE) will not respond effectively to medication for seizure control. Responsive neurostimulation (RNS) is a promising therapy for pediatric patients with drug-resistant epilepsy and has been shown to be an effective therapy for reduc...
| Main Authors: | , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2021-04-01
|
| Series: | Frontiers in Neurology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2021.656585/full |
| _version_ | 1818726498846113792 |
|---|---|
| author | William P. Welch Jasmine L. Hect Taylor J. Abel Taylor J. Abel |
| author_facet | William P. Welch Jasmine L. Hect Taylor J. Abel Taylor J. Abel |
| author_sort | William P. Welch |
| collection | DOAJ |
| description | Up to 20% of pediatric patients with primary generalized epilepsy (PGE) will not respond effectively to medication for seizure control. Responsive neurostimulation (RNS) is a promising therapy for pediatric patients with drug-resistant epilepsy and has been shown to be an effective therapy for reducing seizure frequency and severity in adult patients. RNS of the centromedian nucleus of the thalamus may help to prevent loss of awareness during seizure activity in PGE patients with absence seizures. Here we present a 16-year-old male, with drug-resistant PGE with absence seizures, characterized by 3 Hz spike-and-slow-wave discharges on EEG, who achieved a 75% reduction in seizure frequency following bilateral RNS of the centromedian nuclei. At 6-months post-implant, this patient reported complete resolution of the baseline daily absence seizure activity, and decrease from 3–4 generalized convulsive seizures per month to 1 per month. RNS recordings showed well-formed 3 Hz spike-wave discharges in bilateral CM nuclei, further supporting the notion that clinically relevant ictal discharges in PGE can be detected in CM. This report demonstrates that CM RNS can detect PGE-related seizures in the CM nucleus and deliver therapeutic stimulation. |
| first_indexed | 2024-12-17T21:59:10Z |
| format | Article |
| id | doaj.art-451cba43205d421d84e72fa81683d78f |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-12-17T21:59:10Z |
| publishDate | 2021-04-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj.art-451cba43205d421d84e72fa81683d78f2022-12-21T21:31:02ZengFrontiers Media S.A.Frontiers in Neurology1664-22952021-04-011210.3389/fneur.2021.656585656585Case Report: Responsive Neurostimulation of the Centromedian Thalamic Nucleus for the Detection and Treatment of Seizures in Pediatric Primary Generalized EpilepsyWilliam P. Welch0Jasmine L. Hect1Taylor J. Abel2Taylor J. Abel3Division of Pediatric Neurology, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United StatesDepartment of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, United StatesDepartment of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, United StatesDepartment of Bioengineering, University of Pittsburgh Swanson School of Engineering, Pittsburgh, PA, United StatesUp to 20% of pediatric patients with primary generalized epilepsy (PGE) will not respond effectively to medication for seizure control. Responsive neurostimulation (RNS) is a promising therapy for pediatric patients with drug-resistant epilepsy and has been shown to be an effective therapy for reducing seizure frequency and severity in adult patients. RNS of the centromedian nucleus of the thalamus may help to prevent loss of awareness during seizure activity in PGE patients with absence seizures. Here we present a 16-year-old male, with drug-resistant PGE with absence seizures, characterized by 3 Hz spike-and-slow-wave discharges on EEG, who achieved a 75% reduction in seizure frequency following bilateral RNS of the centromedian nuclei. At 6-months post-implant, this patient reported complete resolution of the baseline daily absence seizure activity, and decrease from 3–4 generalized convulsive seizures per month to 1 per month. RNS recordings showed well-formed 3 Hz spike-wave discharges in bilateral CM nuclei, further supporting the notion that clinically relevant ictal discharges in PGE can be detected in CM. This report demonstrates that CM RNS can detect PGE-related seizures in the CM nucleus and deliver therapeutic stimulation.https://www.frontiersin.org/articles/10.3389/fneur.2021.656585/fullcase reportresponsive neurostimulationdrug-resistant epilepsycentromedian nucleuspediatric generalized epilepsyabsence seizures |
| spellingShingle | William P. Welch Jasmine L. Hect Taylor J. Abel Taylor J. Abel Case Report: Responsive Neurostimulation of the Centromedian Thalamic Nucleus for the Detection and Treatment of Seizures in Pediatric Primary Generalized Epilepsy Frontiers in Neurology case report responsive neurostimulation drug-resistant epilepsy centromedian nucleus pediatric generalized epilepsy absence seizures |
| title | Case Report: Responsive Neurostimulation of the Centromedian Thalamic Nucleus for the Detection and Treatment of Seizures in Pediatric Primary Generalized Epilepsy |
| title_full | Case Report: Responsive Neurostimulation of the Centromedian Thalamic Nucleus for the Detection and Treatment of Seizures in Pediatric Primary Generalized Epilepsy |
| title_fullStr | Case Report: Responsive Neurostimulation of the Centromedian Thalamic Nucleus for the Detection and Treatment of Seizures in Pediatric Primary Generalized Epilepsy |
| title_full_unstemmed | Case Report: Responsive Neurostimulation of the Centromedian Thalamic Nucleus for the Detection and Treatment of Seizures in Pediatric Primary Generalized Epilepsy |
| title_short | Case Report: Responsive Neurostimulation of the Centromedian Thalamic Nucleus for the Detection and Treatment of Seizures in Pediatric Primary Generalized Epilepsy |
| title_sort | case report responsive neurostimulation of the centromedian thalamic nucleus for the detection and treatment of seizures in pediatric primary generalized epilepsy |
| topic | case report responsive neurostimulation drug-resistant epilepsy centromedian nucleus pediatric generalized epilepsy absence seizures |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2021.656585/full |
| work_keys_str_mv | AT williampwelch casereportresponsiveneurostimulationofthecentromedianthalamicnucleusforthedetectionandtreatmentofseizuresinpediatricprimarygeneralizedepilepsy AT jasminelhect casereportresponsiveneurostimulationofthecentromedianthalamicnucleusforthedetectionandtreatmentofseizuresinpediatricprimarygeneralizedepilepsy AT taylorjabel casereportresponsiveneurostimulationofthecentromedianthalamicnucleusforthedetectionandtreatmentofseizuresinpediatricprimarygeneralizedepilepsy AT taylorjabel casereportresponsiveneurostimulationofthecentromedianthalamicnucleusforthedetectionandtreatmentofseizuresinpediatricprimarygeneralizedepilepsy |