SAN FRANCISCO – Deep brain stimulation of the anterior thalamic nuclei shows promise in the management of epileptic seizures, judging from the findings of a small pilot study, Robert Fisher, M.D., said at the annual meeting of the Congress of Neurological Surgeons.
If further research results confirm the procedure's initial promise, deep brain stimulation could become one of a group of targeted therapies, he said.
That group of therapies includes radiation and local drug perfusion, which control severe epileptic seizures, said Dr. Fisher, who is professor of neurology at Stanford (Calif.) University.
The study population consisted of seven men and seven women, 19–44 years old, with partial and apparently generalized tonicoclonic seizures originating in the temporofrontal lobes and from multifocal regions.
Treatment efficacy was expressed in terms of responder rate, defined as the percentage of patients who experienced a decline of 50% or more in the number of seizures after deep brain stimulation.
By that criterion, the responder rate was 57% as long as 12 months post procedure, he reported.
Improvement was especially dramatic in four of five patients whose seizures were severe enough to make them fall down.
There was no control group in the study. However, these findings compare favorably with data that come from controlled clinical trials that involved gabapentin and lamotrigine in which responder rates were only 15%-20% among patients who were taking the drugs, Dr. Fisher pointed out.
One concern about deep brain stimulation is that it may inhibit neurologic activity at seizure foci but stimulate activity in surrounding areas of the brain.
“We will have to watch for that as we move forward,” he said.
A controlled, multicenter trial is now underway.