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Deep Brain Stimulation in Epilepsy: A Role for Modulation of the Mammillothalamic Tract in Seizure Control?

(2020) NEUROSURGERY. 87(3). p.602-610
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Abstract
BACKGROUND: Deep brain stimulation of the anterior nucleus of the thalamus (ANT-DBS) can improve seizure control for patients with drug-resistant epilepsy (DRE). Yet, one cannot overlook the high discrepancy in efficacy among patients, possibly resulting from differences in stimulation site. OBJECTIVE: To test the hypothesis that stimulation at the junction of the ANT and mammillothalamic tract (ANT-MTT junction) increases seizure control. METHODS: The relationship between seizure control and the location of the active contacts to the ANT-MIT junction was investigated in 20 patients treated with ANT-DBS for DRE. Coordinates and Euclidean distance of the active contacts relative to the ANT-MTT junction were calculated and related to seizure control. Stimulation sites were mapped by modelling the volume of tissue activation (VTA) and generating stimulation heat maps. RESULTS: After 1 yr of stimulation, patients had a median 46% reduction in total seizure frequency, 50% were responders, and 20% of patients were seizure-free. The Euclidean distance of the active contacts to the ANT-MTT junction correlates to change in seizure frequency (r' = 0.24, P = .01) and is -30% smaller (P = .015) in responders than in nonresponders. VTA models and stimulation heat maps indicate a hot-spot at the ANT-MTT junction for responders, whereas non-responders had no evident hot-spot. CONCLUSION: Stimulation at the ANT-MTT junction correlates to increased seizure control. Our findings suggest a relationship between the stimulation site and therapy response in ANT-DBS for epilepsy with a potential role for the MTT. DBS directed at white matter merits further exploration for the treatment of epilepsy.
Keywords
HIGH-FREQUENCY STIMULATION, ANTERIOR NUCLEUS, ELECTRICAL-STIMULATION, THALAMUS, TARGET, MRI, CIRCUITS, Neuromodulation, DRE, Drug-resistant epilepsy, Thalamus, Mammillothalamic tract, White matter stimulation

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MLA
Schaper, Frederic L. W. V. J., et al. “Deep Brain Stimulation in Epilepsy: A Role for Modulation of the Mammillothalamic Tract in Seizure Control?” NEUROSURGERY, vol. 87, no. 3, Oxford Univ Press Inc, 2020, pp. 602–10, doi:10.1093/neuros/nyaa141.
APA
Schaper, F. L. W. V. J., Plantinga, B. R., Colon, A. J., Wagner, G. L., Boon, P., Blom, N., … Temel, Y. (2020). Deep Brain Stimulation in Epilepsy: A Role for Modulation of the Mammillothalamic Tract in Seizure Control? NEUROSURGERY, 87(3), 602–610. https://doi.org/10.1093/neuros/nyaa141
Chicago author-date
Schaper, Frederic L. W. V. J., Birgit R. Plantinga, Albert J. Colon, G. Louis Wagner, Paul Boon, Nadia Blom, Erik D. Gommer, et al. 2020. “Deep Brain Stimulation in Epilepsy: A Role for Modulation of the Mammillothalamic Tract in Seizure Control?” NEUROSURGERY 87 (3): 602–10. https://doi.org/10.1093/neuros/nyaa141.
Chicago author-date (all authors)
Schaper, Frederic L. W. V. J., Birgit R. Plantinga, Albert J. Colon, G. Louis Wagner, Paul Boon, Nadia Blom, Erik D. Gommer, Govert Hoogland, Linda Ackermans, Rob P. W. Rouhl, and Yasin Temel. 2020. “Deep Brain Stimulation in Epilepsy: A Role for Modulation of the Mammillothalamic Tract in Seizure Control?” NEUROSURGERY 87 (3): 602–610. doi:10.1093/neuros/nyaa141.
Vancouver
1.
Schaper FLWVJ, Plantinga BR, Colon AJ, Wagner GL, Boon P, Blom N, et al. Deep Brain Stimulation in Epilepsy: A Role for Modulation of the Mammillothalamic Tract in Seizure Control? NEUROSURGERY. 2020;87(3):602–10.
IEEE
[1]
F. L. W. V. J. Schaper et al., “Deep Brain Stimulation in Epilepsy: A Role for Modulation of the Mammillothalamic Tract in Seizure Control?,” NEUROSURGERY, vol. 87, no. 3, pp. 602–610, 2020.
@article{8702969,
  abstract     = {BACKGROUND: Deep brain stimulation of the anterior nucleus of the thalamus (ANT-DBS) can improve seizure control for patients with drug-resistant epilepsy (DRE). Yet, one cannot overlook the high discrepancy in efficacy among patients, possibly resulting from differences in stimulation site. OBJECTIVE: To test the hypothesis that stimulation at the junction of the ANT and mammillothalamic tract (ANT-MTT junction) increases seizure control. METHODS: The relationship between seizure control and the location of the active contacts to the ANT-MIT junction was investigated in 20 patients treated with ANT-DBS for DRE. Coordinates and Euclidean distance of the active contacts relative to the ANT-MTT junction were calculated and related to seizure control. Stimulation sites were mapped by modelling the volume of tissue activation (VTA) and generating stimulation heat maps. RESULTS: After 1 yr of stimulation, patients had a median 46% reduction in total seizure frequency, 50% were responders, and 20% of patients were seizure-free. The Euclidean distance of the active contacts to the ANT-MTT junction correlates to change in seizure frequency (r' = 0.24, P = .01) and is -30% smaller (P = .015) in responders than in nonresponders. VTA models and stimulation heat maps indicate a hot-spot at the ANT-MTT junction for responders, whereas non-responders had no evident hot-spot. CONCLUSION: Stimulation at the ANT-MTT junction correlates to increased seizure control. Our findings suggest a relationship between the stimulation site and therapy response in ANT-DBS for epilepsy with a potential role for the MTT. DBS directed at white matter merits further exploration for the treatment of epilepsy.},
  author       = {Schaper, Frederic L. W. V. J. and Plantinga, Birgit R. and Colon, Albert J. and Wagner, G. Louis and Boon, Paul and Blom, Nadia and Gommer, Erik D. and Hoogland, Govert and Ackermans, Linda and Rouhl, Rob P. W. and Temel, Yasin},
  issn         = {0148-396X},
  journal      = {NEUROSURGERY},
  keywords     = {HIGH-FREQUENCY STIMULATION,ANTERIOR NUCLEUS,ELECTRICAL-STIMULATION,THALAMUS,TARGET,MRI,CIRCUITS,Neuromodulation,DRE,Drug-resistant epilepsy,Thalamus,Mammillothalamic tract,White matter stimulation},
  language     = {eng},
  number       = {3},
  pages        = {602--610},
  publisher    = {Oxford Univ Press Inc},
  title        = {Deep Brain Stimulation in Epilepsy: A Role for Modulation of the Mammillothalamic Tract in Seizure Control?},
  url          = {http://dx.doi.org/10.1093/neuros/nyaa141},
  volume       = {87},
  year         = {2020},
}

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