Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2023 Apr:179:106045.
doi: 10.1016/j.nbd.2023.106045. Epub 2023 Feb 20.

Deep brain stimulation of thalamus for epilepsy

Robert S Fisher  1
Affiliations
Free article
Review

Deep brain stimulation of thalamus for epilepsy

Robert S Fisher. Neurobiol Dis. 2023 Apr.
Free article

Abstract

Neuromodulation (neurostimulation) is a relatively new and rapidly growing treatment for refractory epilepsy. Three varieties are approved in the US: vagus nerve stimulation (VNS), deep brain stimulation (DBS) and responsive neurostimulation (RNS). This article reviews thalamic DBS for epilepsy. Among many thalamic sub-nuclei, DBS for epilepsy has been targeted to the anterior nucleus (ANT), centromedian nucleus (CM), dorsomedial nucleus (DM) and pulvinar (PULV). Only ANT is FDA-approved, based upon a controlled clinical trial. Bilateral stimulation of ANT reduced seizures by 40.5% at three months in the controlled phase (p = .038) and 75% by 5 years in the uncontrolled phase. Side effects related to paresthesias, acute hemorrhage, infection, occasional increased seizures, and usually transient effects on mood and memory. Efficacy was best documented for focal onset seizures in temporal or frontal lobe. CM stimulation may be useful for generalized or multifocal seizures and PULV for posterior limbic seizures. Mechanisms of DBS for epilepsy are largely unknown, but animal work points to changes in receptors, channels, neurotransmitters, synapses, network connectivity and neurogenesis. Personalization of therapies, in terms of connectivity of the seizure onset zone to the thalamic sub- nucleus and individual characteristics of the seizures, might lead to improved efficacy. Many questions remain about DBS, including the best candidates for different types of neuromodulation, the best targets, the best stimulation parameters, how to minimize side effects and how to deliver current noninvasively. Despite the questions, neuromodulation provides useful new opportunities to treat people with refractory seizures not responding to medicines and not amenable to resective surgery.

Keywords: Anterior nucleus of thalamus; Brain stimulation; Centromedian nucleus of thalamus; Dorsomedial nucleus of thalamus; Neuromodulation; Neurostimulation; Pulvinar; Thalamus.

PubMed Disclaimer

Conflict of interest statement

Declaration of Competing Interest Competing interests: Dr. Fisher has no specific competing interests. He was a former consultant to Medtronic and Cyberonics and currently holds stock or options in Avails Medical, Cerebral Therapeutics, Eysz, Irody, Smart Monitor and Zeto.

Similar articles

See all similar articles

Cited by

Publication types