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Brain stimulation a 'promising therapy' for epilepsy
Artwork based on what a patient says an epileptic seizure feels like
Patients in the study had electrodes implanted in their brains
Deep brain stimulation is a promising therapy for epilepsy, US researchers from Stanford University have said.
In a clinical trial, 110 people had electrodes implanted in their brains and their seizures were monitored.
Forty-one per cent of patients showed a reduction in seizures after 13 months while 56% experienced a reduction after two years.
The patients all suffered from regular epileptic seizures and had failed to respond to drug treatment.
Deep brain stimulation (DBS) is a surgical treatment involving the implantation of a medical device called a brain pacemaker, which sends electrical impulses to specific parts of the brain.
In the group of patients who received brain stimulation, researchers noted a 41% reduction in seizures compared to a 14.5% decline in seizures in a control group. This group did not receive stimulation.
Epilepsy is a common neurological disorder which is characterised by recurrent seizures. These seizures can cause temporary loss of consciousness, convulsions, confusion or disturbances in sensations.
According to the World Health Organization, epilepsy affects 50 million people worldwide.
Previous studies indicate that one third of those with epilepsy do not respond to anti-epileptic drugs.
Dr Robert Fisher, director of the Epilepsy Centre at Stanford University and lead author of the study, said electrical deep brain stimulation does reduce seizure frequency in patients.
But he cautioned: "DBS therapy is invasive and serious complications can occur. Additional clinical knowledge would help to determine the best candidates for DBS therapy."
Simon Wigglesworth, deputy chief executive at UK charity Epilepsy Action, said: "We have been hopeful for some time that deep brain stimulation may be a treatment option for some people with epilepsy.
"This study is exciting news and could be an important development in the treatment of epilepsy in the 30% of people whose seizures don't respond to traditional drug therapies."
The research is published online in the journal Epilepsia.
Electrical stimulation of the anterior nucleus of thalamus for treatment of refractory epilepsy
*Robert Fisher, †Vicenta Salanova, †Thomas Witt, †Robert Worth, ‡Thomas Henry, ‡Robert Gross, §Kalarickal Oommen, ¶Ivan Osorio, ¶Jules Nazzaro, #Douglas Labar, #Michael Kaplitt, **Michael Sperling, ††Evan Sandok, ††John Neal, ‡‡Adrian Handforth, §§John Stern, ‡‡Antonio DeSalles, ¶¶Steve Chung, ¶¶Andrew Shetter, ##Donna Bergen, ##Roy Bakay, *Jaimie Henderson, ***Jacqueline French, ***Gordon Baltuch, †††William Rosenfeld, †††Andrew Youkilis, ‡‡‡William Marks, ‡‡‡Paul Garcia, ‡‡‡Nicolas Barbaro, §§§Nathan Fountain, ¶¶¶Carl Bazil, ¶¶¶Robert Goodman, ¶¶¶Guy McKhann, ###K. Babu Krishnamurthy, ###Steven Papavassiliou, ‡Charles Epstein, ***John Pollard, ****Lisa Tonder, ****Joan Grebin, ****Robert Coffey, ****Nina Graves, and the SANTE Study Group1
*Stanford University, Stanford, California, U.S.A. ; †Indiana University, Indianapolis, Indiana, U.S.A. ; ‡Emory University, Atlanta, Georgia, U.S.A. ; §University of Oklahoma, Oklahoma City, Oklahoma, U.S.A. ; ¶University of Kansas, Kansas City, Kansas, U.S.A. ; #Weill-Cornell, New York, New York, U.S.A. ; **Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A. ; ††Marshfield Clinic, Marshfield, Wisconsin, U.S.A. ; ‡‡Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, U.S.A. ; §§Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A. ; ¶¶Barrow Neurological Institute, Phoenix, Arizona, U.S.A. ; ##Rush Presbyterian St. Luke's Medical Center, Chicago, Illinois, U.S.A. ; ***University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A. ; †††St. Luke's N. Medical Building, St. Louis, Missouri, U.S.A. ; ‡‡‡University of California San Francisco, California, U.S.A. ; §§§University of Virginia School of Medicine, Charlottesville, Virginia, U.S.A. ; ¶¶¶Columbia University College of Physicians and Surgeons, New York, New York, U.S.A. ; ###Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A. ; and ****Medtronic, Minneapolis, Minnesota, U.S.A.
Address correspondence to Robert S. Fisher, M.D., Ph.D., Department of Neurology, Room A343, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305-5235, U.S.A. E-mail: firstname.lastname@example.org
1 The SANTE Study Group is given in Appendix.
Copyright © 2010 International League Against Epilepsy
Epilepsy • Seizures • Deep brain stimulation • Epilepsy surgery • Thalamus
Purpose: We report a multicenter, double-blind, randomized trial of bilateral stimulation of the anterior nuclei of the thalamus for localization-related epilepsy.
Methods: Participants were adults with medically refractory partial seizures, including secondarily generalized seizures. Half received stimulation and half no stimulation during a 3-month blinded phase; then all received unblinded stimulation.
Results: One hundred ten participants were randomized. Baseline monthly median seizure frequency was 19.5. In the last month of the blinded phase the stimulated group had a 29% greater reduction in seizures compared with the control group, as estimated by a generalized estimating equations (GEE) model (p = 0.002). Unadjusted median declines at the end of the blinded phase were 14.5% in the control group and 40.4% in the stimulated group. Complex partial and "most severe" seizures were significantly reduced by stimulation. By 2 years, there was a 56% median percent reduction in seizure frequency; 54% of patients had a seizure reduction of at least 50%, and 14 patients were seizure-free for at least 6 months. Five deaths occurred and none were from implantation or stimulation. No participant had symptomatic hemorrhage or brain infection. Two participants had acute, transient stimulation-associated seizures. Cognition and mood showed no group differences, but participants in the stimulated group were more likely to report depression or memory problems as adverse events.
Discussion: Bilateral stimulation of the anterior nuclei of the thalamus reduces seizures. Benefit persisted for 2 years of study. Complication rates were modest. Deep brain stimulation of the anterior thalamus is useful for some people with medically refractory partial and secondarily generalized seizures.
Accepted January 26, 2010; Early View publication Xxxxx xx, xxxx.
DIGITAL OBJECT IDENTIFIER (DOI)
10.1111/j.1528-1167.2010.02536.x About DOI
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