• Vibhor Krishna, Nicolas Kon Kam King, Francesco Sammartino, Ido Strauss, Danielle M Andrade, Richard A Wennberg, and Andres M Lozano.
• ‡Division of Neurosurgery, ¶Department of Neurology, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada; §Department of Neurosurgery, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel.
• Neurosurgery. 2016 Jun 1; 78 (6): 802-11.

BackgroundAnterior nucleus (AN) deep brain stimulation (DBS) is a palliative treatment for medically refractory epilepsy. The long-term efficacy and the optimal target localization for AN DBS are not well understood.ObjectiveTo analyze the long-term efficacy of AN DBS and its predictors.MethodsWe performed a retrospective review of 16 patients who underwent AN DBS. We selected only patients with reliable seizure frequency data and at least a 1-year follow-up. We studied the duration of the seizure reduction after DBS insertion and before stimulation (the insertional effect) and its association with long-term outcome. We modeled the volume of activation using the active contacts, stimulation parameters, and postoperative imaging. The overlap of this volume was plotted in Montreal Neurological Institute 152 space in 7 patients with significant clinical efficacy.ResultsNine patients reported a decrease in seizure frequency immediately after electrode insertion (insertional or microthalamotomy effect). The duration of insertional effect varied from 2 to 4 months. However, 1 patient had a long-term insertional effect of 36 months. Altogether, 11 patients reported >50% decrease in seizure frequency with long-term stimulation. The most common pattern of seizure control was immediate and sustained stimulation benefit (n = 8). In patients with long-term stimulation benefit, the efficacious target was localized in the anteroventral AN in close proximity to the mammillothalamic tract.ConclusionAN DBS is efficacious in the control of seizure frequency in selected patients. An insertional effect is commonly observed (56%). The most efficacious site of stimulation appears to be the anteroventral AN.AbbreviationsAN, anterior nucleusDBS, deep brain stimulationMNI, Montreal Neurological InstituteMRE, medical refractory epilepsyMT, mammillothalamic tractSANTE, Stimulation of the Anterior Nucleus of the Thalamus for EpilepsyVNS, vagal nerve stimulation.

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