SUMMARY
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 signifi-
cantly 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.
KEY WORDS: Epilepsy, Seizures, Deep brain stimulation,
Epilepsy surgery, Thalamus.
SUMMARYPurpose: We report a multicenter, double-blind, randomizedtrial of bilateral stimulation of the anterior nuclei ofthe thalamus for localization-related epilepsy.Methods: Participants were adults with medically refractorypartial seizures, including secondarily generalizedseizures. Half received stimulation and half no stimulationduring a 3-month blinded phase; then all receivedunblinded stimulation.Results: One hundred ten participants were randomized.Baseline monthly median seizure frequency was 19.5. Inthe last month of the blinded phase the stimulated grouphad a 29% greater reduction in seizures compared withthe control group, as estimated by a generalized estimatingequations (GEE) model (p = 0.002). Unadjusted mediandeclines at the end of the blinded phase were 14.5% inthe control group and 40.4% in the stimulated group.Complex partial and ‘‘most severe’’ seizures were signifi-cantly reduced by stimulation. By 2 years, there was a 56%median percent reduction in seizure frequency; 54% ofpatients had a seizure reduction of at least 50%, and 14patients were seizure-free for at least 6 months. Fivedeaths occurred and none were from implantation orstimulation. No participant had symptomatic hemorrhageor brain infection. Two participants had acute, transientstimulation-associated seizures. Cognition andmood showed no group differences, but participants inthe stimulated group were more likely to report depressionหรือปัญหาหน่วยความจำที่เป็นเหตุการณ์สนทนา: กระตุ้นทวิภาคีของแอลฟาแอนทีเรียร์ของทาลามัสลดเส้น ยังคงคุณประโยชน์ของ2 ปีการศึกษา ภาวะแทรกซ้อนอัตราเจียมเนื้อเจียมตัว ลึกกระตุ้นสมองของทาลามัสแอนทีเรียร์มีประโยชน์สำหรับการบางคนบางส่วนทาง refractory และเชื่อมเส้นเมจแบบทั่วไปคำสำคัญ: โรคลมชัก เส้น กระตุ้นสมองลึกผ่าตัดโรคลมชัก ทาลามัส
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