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DEEP BRAIN STIMULATION FOR TREATMENT OF REFRACTORY EPILEPSY.
Cukiert A; Burattini JA; Mariani PP; Seda L; Forster CR; Cukiert CM; Argentoni-Baldochi M; Baise-Zung C; Mello VA.
Epilepsy Surgery Program, Hospital Brigadeiro, São Paulo SP, Brazil (acukiert@uol.com.br)
Rationale: Deep brain stimulation (DBS) for treatment of refractory epilepsy has been actively investigated over the last decades as a treatment modality option in patients who had failed or are not candidates for conventional resective or disconnective surgery. We report the findings in 4 patients submitted to DBS.
Methods: Four adult patients with refractory epilepsy were studied. Patient 1, a 18-years old man, had a diagnosis of Lennox-Gastaut syndrome and multiform daily seizures since the age of 8. He was submitted to a maximized (90%) callosal section by the age of 10. After callosotomy, he got 95% seizure frequency reduction and improvement in his cognitive status; he continued to have 1-2 tonic seizures / week. He was submitted to DBS targeted bilaterally at the centro-median nucleus of the thalamus using a Kinetra device (Medtronics). Present electrode settings are: 2V, 300usec and 100 Hz (18 months of follow-up). Patient 2, a 32-years old woman, had refractory bi-temporal lobe epilepsy with daily seizures since the age of 6. She had been submitted to cortico-amygdalo-hippocampectomy four years ago; she continued to have 2-3 seizures / week after surgery. She was submitted to DBS targeted bilaterally at the ventral-anterior nucleus of the thalamus using a Kinetra device (Medtronics). Present electrode settings are: 2,25V, 300usec and 100 Hz (18 months of follow-up). Both patients had presently 4 months of follow-up. Patient 3, a 32-years old man, had refractory primary generalized epilepsy with daily seizures since the age of 8 years. He was submitted to callosal section 2 years before implantation and got 90% reduction in seizure frequency. He still had 1 seizure / day before implantation. He was submitted to DBS targeted bilaterally at the centro-median nucleus of the thalamus using a Kinetra device (Medtronics). Present electrode settings are: 1V, 300usec and 130 Hz (6 months of follow-up). Patient 4, a 34-years old woman, had refractory primary generalized epilepsy with daily seizures since the age of 4 years. She was submitted to callosal section 18 months before implantation and got 85% reduction in seizure frequency. She still had 1-2 seizures / day before implantation. She was submitted to DBS targeted bilaterally at the centro-median nucleus of the thalamus using a Kinetra device (Medtronics). Present electrode settings are: 0.8V, 300usec and 130 Hz (6 months of follow-up).
Results: Patient 1 got an additional seizure frequency reduction; presently has 1 seizure / month. Interestingly, he is much more alert and verbal output is much higher than before DBS. Patient 2 remained seizure free for 2 months after DBS. Her present seizure frequency is 2 seizures / month. Patient 3 got an additional seizure frequency reduction; presently has 1 seizure / week. Patient 4 got an additional seizure frequency reduction; presently has 1 seizure / 10 days. All patients presented increased attention with stimulation parameters lower then those required for seizure control.
Discussion: All patients benefited from the procedure. We are targeting the centro-median nucleus for patients with generalized epilepsy and the ventral-anterior nucleus in patients with focal epilepsy. Additional follow-up is needed to adequately assess the clinical outcome after DBS. Improvement in the attention deficit is precocious and seems unrelated to seizure control.
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