• Erik H Middlebrooks, Ayushi Jain, Lela Okromelidze, Chen Lin, Erin M Westerhold, Chad A O'Steen, Anthony L Ritaccio, Alfredo Quiñones-Hinojosa, William O Tatum, and Sanjeet S Grewal.
• Department of Radiology, Division of Neuroradiology, Mayo Clinic, Jacksonville, Florida, USA.
• Neurosurgery. 2021 Oct 13; 89 (5): 901-908.

BackgroundDeep brain stimulation (DBS) of the anterior nucleus of the thalamus (ANT) is an increasingly utilized treatment of drug-resistant epilepsy. To date, the effect of high-frequency stimulation (HFS) vs low-frequency stimulation (LFS) in ANT DBS is poorly understood.ObjectiveTo assess differences in the acute effect of LFS vs HFS in ANT DBS utilizing blood-oxygen-level-dependent (BOLD) functional magnetic resonance imaging (fMRI).MethodsIn this prospective study of 5 patients with ANT DBS for epilepsy, BOLD activation and deactivation were modeled for 145-Hz and 30-Hz ANT stimulation using an fMRI block design. Data were analyzed with a general linear model and combined via 2-stage mixed-effects analysis. Z-score difference maps were nonparametrically thresholded using cluster threshold of z > 3.1 and a (corrected) cluster significance threshold of P = .05.ResultsHFS produced significantly greater activation within multiple regions, in particular the limbic and default mode network (DMN). LFS produced minimal activation and failed to produce significant activation within these same networks. HFS produced widespread cortical and subcortical deactivation sparing most of the limbic and DMN regions. Meanwhile, LFS produced deactivation in most DMN and limbic structures.ConclusionOur results show that HFS and LFS produce substantial variability in both local and downstream network effects. In particular, largely opposing effects were identified within the limbic network and DMN. These findings may serve as a mechanistic basis for understanding the potential of HFS vs LFS in various epilepsy syndromes.© Congress of Neurological Surgeons 2021.

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